Neurologic Complications of Critical Illness

Author: Eelco F. Wijdicks
Published: December 2001
Publisher: Oxford University Press
ISBN: 0195140796
Hardcover Book
Number of Pages: 415

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This edition incorporates advances in acute neurology practiced in medical and surgical intensive care and transplantation units since the 1995 edition, Neurology of critical illness. Additions are new chapters on evaluating coma/other altered states of awareness, complications in the critically ill pregnant patient, and withdrawal of life support from a neurologist's perspective; new figures; and greater definitional clarity based on newer techniques. Neurologists like Wijdicks (Mayo Medical School, Rochester, MN) still play the role, noted in the foreword to the first edition, of "... arbiters of such diverse problems as brain death, postoperative neurologic complications, and respiratory and medical decisions in patients with Guillan-Barré syndrome and myasthenia gravis." Coverage of traumatic head injury and spinal cord injury is cursory.

Table of Contents
Pt. I General Clinical Neurologic Problems in the Intensive Care Unit
1 Coma and Other States of Altered Awareness 3
Definitions of Altered States of Consciousness 3
Neuroanatomy and Neuropharmacology of Consciousness 5
Neurologic Examination of the Acutely Confused Patient 6
Neurologic Examination of Comatose Patients 8
Brain Herniation Syndromes 15
Neurologic Examination in Brain Death 16
Neuroimaging in Coma 18
Special Clinical Situations and Problems 18
Approach to the Acutely Confused and Delirious Patient 23
Approach to the Comatose Patient 24
Approach to Brain Death 24
2 Neurologic Manifestations of Pharmacologic Agents Commonly used in the Intensive Care Unit 28
Principles of Pharmacodynamics and Pharmacokinetics in Critical Illness 28
Effect of Drugs on Neuromuscular Function 31
Effect of Drugs on Level of Consciousness 34
Commonly Used Drugs with Direct Neurotoxic Effects 36
3 Seizures in the Intensive Care Unit 46
Generalized Tonic-Clonic Seizures 46
Drug-Induced and Drug-Withdrawal Seizures 47
Seizures and Acute Metabolic Derangements 49
Seizures and Structural Central Nervous System Abnormalities 49
Convulsive Status Epilepticus 49
Nonconvulsive Status Epilepticus 54
Management of Seizures and Status Epilepticus 54
Outcome 58
4 Generalized Weakness in the Intensive Care Unit 63
General Considerations 63
Disorders of the Spinal Cord 64
Disorders of Peripheral Nerves 65
Disorders of the Neuromuscular Junction 65
Disorders of Skeletal Muscle 66
Electrodiagnostic Studies 68
5 Neurologic Complications of Invasive Procedures in the Intensive Care Unit 72
General Considerations 73
Neurologic Complications Associated with Specific Procedures 75
Pt. II Neurologic Complications in Medical and Surgical Intensive Care Units and Transplantation Units
6 Neurologic Manifestations of Bacterial Infection and Sepsis 93
Bacterial Meningitis 93
Spinal Epidural Abscess 97
Infective Endocarditis 99
Clostridial Syndromes 108
Sepsis 110
7 Neurologic Complications of Cardiac Arrest 123
General Considerations in Resuscitation Medicine 123
Postresuscitation Encephalopathy 125
Treatment and Supportive Care 137
8 Neurologic Manifestations of Acid-Base Derangements, Electrolyte Disorders, and Endocrine Crises 143
Acid-Base Disorders 143
Electrolyte Disorders 147
Endocrine Emergencies 161
9 Neurologic Complications of Acute Renal Disease 174
Uremic Encephalopathy 174
Dialysis Dysequilibrium Syndrome 177
Hypertensive Encephalopathy 179
Neuromuscular Disorders 183
10 Neurologic Manifestations of Acute Hepatic Failure 190
General Considerations 190
Hepatic Encephalopathy 191
11 Neurologic Complications Associated with Disorders of Thrombosis and Hemostasis 207
Disseminated Intravascular Coagulation 208
Thrombolysis and Anticoagulation 211
Thrombotic Thrombocytopenic Purpura 218
12 Neurologic Complications of Acute Vasculitic Syndromes 226
General Considerations 226
Polyarteritis Nodosa 227
Churg-Strauss Syndrome 231
Wegener's Granulomatosis 233
Drug-Induced Vasculitis 234
13 Neurologic Complications in the Critically Ill Pregnant Patient 238
Eclampsia 238
HELLP Syndrome 242
Amniotic Fluid Embolism 243
Neurologic Complications of Tocolytic Agents 245
14 Neurologic Complications of Aortic Surgery 248
Vascular Anatomy of the Spinal Cord 248
Scope of the Problem 250
Neurologic Features of Spinal Cord Infarction 253
Diagnostic Evaluation of Spinal Cord Infarction 254
Therapeutic Options 257
Plexopathies 258
Aortic Dissection 258
15 Neurologic Complications of Cardiac Surgery 263
General Considerations 263
Ischemic Stroke 268
Neuropsychologic Impairment 273
Retinal Damage 275
Peripheral Nerve Damage 276
16 Neurologic Complications of Acute Environmental Injuries 284
Thermal Burns 284
Smoke Inhalation 288
Electrical Burns 290
Lightning Injury 291
Accidental Hypothermia 293
Heat Stroke 295
Near-Drowning 296
17 Neurologic Complications of Multisystem Trauma 302
Clinical Spectrum of Head Injury 303
Neuroradiologic Findings in Head Injury 304
General Principles of Management 310
Management of Increased Intracranial Pressure 312
Management of Traumatic Intracranial Hematomas 315
Management of Traumatic Cerebral Aneurysm 317
Trauma of Spine and Spinal Cord 319
Acute Spinal Cord Injury 326
Post-Traumatic Neuropathies Associated with Fractures 326
Fat Embolism Syndrome 329
18 Neurologic Complications of Organ Transplantation 337
General Considerations in Transplantation 338
Neurologic Complications in Transplantation 340
Neurologic Complications of Graft-Versus-Host Disease 362
Pt. III Outcome in Central Nervous System Catastrophes
19 Outcome of Acute Injury to the Central Nervous System 373
Description of Outcome Categories After Coma 373
Outcome in Metabolic Encephalopathies 375
Outcome in Stroke 381
Outcome in Head Injury 383
Outcome in Traumatic Spine Injury 384
20 Withdrawing Life Support in the Intensive Care Unit: A Neurologist's Perspective 389
General Considerations 390
Legal Aspects of Withdrawal of Care 390
Decisions in Withdrawal of Care 391
Withdrawal of Care 392
Withdrawal of Care in Special Neurologic Circumstances 393
Index 397

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