Central nervous system (CNS) infections are uncommon amongst the immunocompetent population. A state of immuno-incompetency increases susceptibility of the CNS to infection. CNS infections incur serious burden on the morbidity and mortality of cancer patients
Encephalitis is defined as the inflammation of the brain parenchyma. The inflammatory changes can lead to headache, stiffness in neck, sensitivity to light, confusion, seizures and focal neurologic deficits. Viral encephalitis is the most common type of encephalitis and often coexists with viral meningitis.
Classifying the type of status epilepticus is important in determining morbidity and aggressiveness of treatment required. Clinical manifestations vary according to the type of seizure the patient experiences and yet diagnosis is made clinically based on those clinical manifestations. This chapter will help you understand the classification and how to diagnose patient based on clinical features.
The traumatic spinal cord injury often results from a gunshot wound (10.4%), accidental trauma to the head, neck, and back region (31.5%), falling (25.3%), and spinal sports injuries (4.3%) while non-traumatic spinal cord injuries can vary. The main purpose of this chapter is to help you understand the difference between complete and incomplete cord transection and different types of spinal injuries.
When patients fail first-line therapy which is a sufficient dose of benzodiazepines and at least one AED as second-line therapy, irrespective of time this is termed refractory status epilepticus. Primary drugs being used for refractory status epilepticus are Midazolam, Propofol, and Ketamine while other interventions include DBS, surgery, VNS, etc. This chapter focuses on the treatment strategies being involved to treat patients with refractory status epilepticus
During cerebral autoregulation, optimal perfusion pressure is maintained by changes in Cerebrovascular resistance. CBF is kept relatively constant through the change in vessel diameter at the CPP range of 40-140 mmHg. It is controlled by means of myogenic, metabolic, and neurogenic factors, and partial pressure of arterial blood gases (CO2 and O2), cerebral metabolism, and the autonomic nervous system are primary determinants of CBF.
Risk of DVT in at-risk medical patients without anticoagulant prophylaxis is10–15%. PE occurs in up to 50% of patients with DVT. While giving prophylaxis of venous thrombosis, a physician needs to know about contraindication and should use Neurocritical Care Society Guideline Recommendation.
Short term (7-10 days) prophylaxis with ASM is recommended for Severe TBI. Prophylactic administration of Anti-Seizure Medications (ASMs) is used as a measure to decrease the risks of post-traumatic seizures and progression into post-traumatic epilepsy (PTE) and most commonly used are Phenytoin or Levetiracetam.
Permanent, irreversible termination of cerebral and brainstem functions including the ability to regulate respiratory activities. American Academy of Neurology has provided criteria to diagnose brain death but most states and hospitals have their own criteria so make sure to use your local criteria if that is available.
Continuous EEG monitoring device with a video camera for at least 24 hours in a conscious patient reflecting cortical synaptic activity. CEEG is most commonly performed in ICU settings in order to monitor critically ill patients. Neuronal activity depends on the blood supply hence it makes EEG monitoring reliable to check for brain ischemia. Automated displays help to interpret raw EEG effectively. Commonly used techniques for these displays are Color density spectral array and Amplitude-integrated EEG. This chapter will help you understand the concepts of continuous EEG, it’s indications, and utilization in different settings along with the emphasis on the advantages to use this technique.
Acute seizures are a common complication following spontaneous intracerebral hemorrhage (sICH). The incidence of post ICH seizures rate is estimated to be between 4%-16%. Current guidelines have limited recommendations due to the paucity of data.
Spontaneous intracerebral hemorrhage is defined as focal bleeding from the blood vessel into parenchyma of the brain in the absence of trauma or surgery. ICH is a medical emergency requiring immediate treatment. Less common than ischemic stroke but is more serious.
Change in level of consciousness associated with altered cognition and/or perception appearing over hours/days that is not secondary to prior/developing chronic dementia. Encephalopathy results in acute structural brain changes to non-structural, metabolic, toxic, infection related brain dysfunction
Extravasation of blood into the subdural space between the dura and arachnoid membranes. Most common neurosurgical emergency associated with high morbidity and mortality. A potentially life-threatening condition requiring urgent surgical evacuation for good clinical outcomes
Status epilepticus (SE) is defined as ≥5 minutes of continuous clinical and/or electrographic seizure activity or recurrent seizure activity without recovery (returning to baseline) between seizures