A Joseph Layon Andrea Gabrielli William A Friedman Editors Textbook of Neurointensive Care Second Edition 123 Textbook of Neurointensive Care A Joseph Layon • Andrea Gabrielli William A Friedman Editors Textbook of Neurointensive Care Second Edition Editors A Joseph Layon, MD, FACP Critical Care Medicine Pulmonary and Critical Care Medicine The Geisinger Health System Danville PA USA Andrea Gabrielli, MD, FCCM Departments of Anesthesiology and Surgery University of Florida College of Medicine Gainesville FL USA Temple University School of Medicine Philadelphia PA USA William A Friedman, MD Department of Neurological Surgery University of Florida College of Medicine Gainesville FL USA ISBN 978-1-4471-5225-5 ISBN 978-1-4471-5226-2 DOI 10.1007/978-1-4471-5226-2 Springer London Heidelberg New York Dordrecht (eBook) Library of Congress Control Number: 2013945859 © Springer-Verlag London 2013 This work is subject to copyright All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher's location, in its current version, and permission for use must always be obtained from Springer Permissions for use may be obtained through RightsLink at the Copyright Clearance Center Violations are liable to prosecution under the respective Copyright Law The use of general descriptive names, registered names, trademarks, service marks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made The publisher makes no warranty, express or implied, with respect to the material contained herein Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) To my family—Susana Picado, Maria Layon-Taylor, Nicolas Layon, Daniel Layon—all in the service of our people and country All of whom have sacrificed To those who are in search of a home, family, country: may you find them To those who struggle to become: may you be —A Joseph Layon To my father Pietro and my mother Giuliana, now walking the family dog between the clouds, for being my role models and the inspiration behind all my efforts To my brother and friend Marco, the real smart guy of the family To my students, friends, and colleagues worldwide To our patients, our inspiration for compassionate care, our reason to try harder —Andrea Gabrielli To my many colleagues, friends, and patients who have taught me so much about neurosurgery —William A Friedman Foreword to the Second Edition During the years since the publication of the first edition of this Textbook of Neurointensive Care, considerable developments have evolved in the critical care of the neurologically injured patient This second edition captures such advances presented by more than 100 leading authorities, offering a clear and comprehensive update It represents a collective accomplishment of clinician scientists dedicated to providing such enormous material and thereby extensive knowledge in the care of the brain injured from the emergency department to the ICU, to the operating room, and through the postoperative period This edition is the only textbook providing such a comprehensive offering throughout the continuum of care Such a continuum of critical care is exemplified throughout this second edition in its extensive chapters A presentation of key concepts of brain physiology essential to the understanding of intracranial hypertension is offered in the chapter on elevated intracranial hypertension Despite recent advances in the treatment, diagnosis, and management of aneurysms and cerebral vasospasm, morbidity and mortality remain high and are addressed in the chapter on treatment of aneurysmal subarachnoid hemorrhage The chapter on intracranial hemorrhage is an essential presentation Such hemorrhage remains formidable as patient outcome is still poor, despite recent advances that have led to extensive research establishing evidence-based management This chapter notes the disparate incidence of stroke in African-Americans and discusses possible risk factors in this population Neuroradiologic imaging is discussed in a substantial chapter, providing an understanding of how such images are created utilizing MRI and CT modalities though technical presentation The chapter on pharmacotherapy in the neurosurgical ICU is a further example of the comprehensive approach to such care extended by this second edition Knowledge of pharmacokinetics and pharmacodynamics of neuroactive drugs is provided for the optimal management of neuroinjured patients In addition to these chapters, all the contributions provide evidenced-based data and algorithms for decision making and illustrate key points; multiple supporting references are provided for documentation and reviews This second edition is improved in its sectioning with the provision of an Introduction (Part I) which presents fundamentals of neurocritical care issues of organization, quality improvement, and the emerging ICU subspecialty of Neurointensive Care Medicine Part II addresses Neuroanatomy and Neurophysiology; Part III covers Neuromonitoring; Part IV addresses in detail the Neuroinjured Patient; Part V details Special Situations such as traumatic brain injury in the adult and as well as in the pediatric population, the treatment of spinal cord injury, and the treatment of seizures; Part VI provides Situations of Special Interest such as intraoperative neuroanesthesia, neurorehabilitation, and brain death and the management of potential organ donation This section also reviews the ongoing concerns of ethical issues in the neurointensive care unit In 2003, the year prior to the publication of the first edition of the Textbook of Neurocritical Care, the Joint Commission (JC, formerly JCAHO) launched the Primary Stroke Center Certification Program During the years since the First Edition, more than 925 certified primary stroke centers have been established in 48 states, with comprehensive stroke centers now being certified by JC in several states The Get With The Guidelines-Stroke National Quality Improvement and Registry Program of the American Heart/American Stroke Association has vii viii Foreword to the Second Edition grown rapidly over these years Over 1,400 hospitals are participating in this program The first edition of this textbook and its editors and authors have contributed immensely to the quality and outcomes of stroke care of these programs Interim and current developments so comprehensively provided now in this second edition will further enhance such care It is a pleasure and privilege to continue to work with such accomplished investigators This second edition is a tribute and an essential contribution to the care of the neurologically injured Danville, PA, USA Edgar J Kenton III, MD, FAAN, FAHA Preface to the Second Edition We claimed, in the Preface to the First Edition of Textbook of Neurointensive Care, that in the near future our hospitals would be composed of EDs, ICUs, and operating rooms Studies of hospitals seem to have borne this out And while we still are not sure of the precise dimensions and shape it will take, health care (maybe better put, health insurance) reform will impact our work and work environment significantly Even those of us who hoped for a reformed health system when the First Edition went to press had no idea, even in our heart of hearts, that in 2013 we would see the beginnings—just that—of the reform of our health-care system In this context, we have attempted to change and improve our Textbook of Neurointensive Care In this second edition, there is more emphasis on evidence-based medicine—our jumpoff point, not our end point—and best practice We have improved chapters on the organization of neurocritical care (Chap 1) and quality improvement (Chap 2); enhanced chapters on neuromonitoring (Chaps and 8) and on the prehospital care of the neurologically injured patient (Chap 9); and added chapters on neuroendocrine function (Chap 15), on hematological/ thrombotic issues (Chaps 16 and 17), and on acute kidney injury and the neurologically injured patient (Chap 19) Additionally, there is an entire chapter (Chap 36) on temperature regulation Finally, we have added a chapter on brain death and the management of the potential organ donor (Chap 44) The reader will note that we eliminated the section on “The Future of NeuroCritical Care.” We are good, but not that good! We cannot see into the future any better than anyone else can! We thank our contributors for their hard work We are in debt to them in a manner that will never be paid And the same goes for our editor and publisher, Elizabeth Corra and Grant Weston: they have the patience of saints Let us know what you think of this second edition As always, the errors in this book belong to the three editors Gainesville, FL, USA Gainesville, FL, USA Gainesville, FL, USA A Joseph Layon, MD, FACP Andrea Gabrielli, MD, FCCM William A Friedman, MD ix 974 Hematologic disorders (cont.) increased blood count erythrocytosis, 332–333 leukocytosis, 334 thromboytoses, 333–334 Heparin-induced thrombocytopenia (HIT), 331 Hepatic encephalopathy, 420 Heterotopic ossification (HO), 677–678 High frequency oscillatory ventilation (HFOV), 24 High grade gliomas (HGGs) anti-angiogenic agents, 716 RT, 716 Histoplasmosis, 476–477 Hoffman twitching, 73, 77 Homonymous hemianopia, 77 Horner’s syndrome, 526, 645 Human immunodeficiency virus (HIV) infection cytomegalovirus cell-mediated immunity, 485 diagnosis, 485–486 treatment, 486 encephalopathy and dementia, 486–487 Toxoplasma gondii clinical manifestation, 482 diagnosis, 482–484 in Europe, 482 treatment, 484–485 in United States, 481–482 Hydrocephalus, 93–94, 468, 837, 838 Hydrotherapy, 885–886 Hyperalimentation (HAL), 401 Hyperkalemia causes of, 372 clinical manifestation, 372 management of, 372 Hypernatremia clinical manifestation, 366 diabetes insipidus (DI), 367 in neurointensive care unit, 366–367 polyuric patient management indomethacin, 370 intake and output documentation, 370 thiazide, 370 total body water (TBW), 367–368 volume replacement, 367 Hypertension, 418 Hypertensive encephalopathy (HE) magnetic resonance imaging, 251 nitroprusside, 251 Hypertonic saline (HTS) treatment, 595 Hypoglycemia, 159 Hypokalemia, 372–373 Hyponatremia cerebral salt wasting (CSW), 363–365 diagnostic workup ADH level, 361 central venous pressure (CVP), 360–361 diagnostic protocol, 361, 362 physical exam (PE), 360 in SAH, 361 evaluation of, 359–360 mortality rates, 359 SIADH, 363 treatment of, 361, 363 Hypothalamic-pituitary axis (HPA) adenohypophysis, 294 neurohypophysis, 294 Index pathophysiology etiology, 295–296 management, 297 symptomatology and diagnosis, 296–297 Hypothermia application, 156–157 complications of, 155–156 induction, 154–155 maintenance of, 155 neuroprotection, 844, 845 rewarming, 155 subarachnoid hemorrhage, 157 targeted temperature management, 154 traumatic brain injury, 157 Hypoxemia, 28–31 Hypoxia, 835–836 Hypoxic vasoconstriction physiology (HPV), 34 I ICA See Internal carotid artery (ICA) ICP See Intracranial pressure (ICP) ICU-acquired weakness clinical presentation, 790 diagnosis, 790 electrophysiology, 790 genetic testing, 796 imaging, 795 laboratory testing autoimmune and hematological testing, 794 CPK, 794 CSF testing, 794–795 demyelination related testing, 795 neuromuscular junction related testing, 795 routine testing, 794 management, 790 neurological signs abnormal movements, 794 cranial nerve examination, 793 motor and reflex examination, 793–794 sensory examination, 793 neurophysiology EMG, 795 H-reflex and F-wave studies, 796 nerve conduction studies, 796 respiratory testing blood gases, 795 lung function test, 795 sniff test, 795 risk factors, 790 symptoms autonomic, 792 cardiorespiratory considerations, 792 history, 792 sensory changes, 791–792 weakness, 791 tissue testing, 796 vital signs and cardiorespiratory examination airway, 792–793 breathing, 793 circulation, 793 ICU physician staffing (IPS), Indomethacin, 370 Inferior vena cava (IVC) filters, 346 Inhaled nitric oxide (iNO), 230 Institute of medicine (IOM), patient injury, 10 quality improvement, 10 Index Intensive blood pressure reduction in acute cerebral hemorrhage trial (INTERACT), 246 Intensive care delirium screening checklist (ICDSC), 410 Intensive care unit (ICU), 683 history and evolution limiting factor, NIH, neuroanatomy (see Neuroanatomy) neurocritical care, organization, 4–5 physician extenders, physician staffing, quality metrics checklist, data collection, health care quality, institute of medicine, special units, subspecialty ABMS, 20 CoBaTrICE, 21 diplomates, 24 neurointerventional techniques, 23 neuromuscular diseases, 23 nursing staff, 23 OB/GYN, 21 pulmonary issues, 20 SCCM, 20 traumatically brain-injury, 23 UCNS, 24 UEMS, 21 training, 22 vasoactive agent antihypertensive agents, 953 hydralazine, 953–954 inotropes, 951–952 labetalol, 953–954 nicardipine, 953 sodium nitroprusside, 953 vasopressors, 952 weak patients in acute poliomyelitis, 784 acute porphyria, 785–786 blood gases, 782 botulism, 787 circulation, 782–783 clinical judgment, 782 diphtheria, 788 discharge planning, 788, 789 GBS, 784–785 history, 779 hypokalemic periodic paralysis, 788 laboratory testing, 780–781 LEMS, 786–787 lung function testing, 782 MRI, 781 myasthenia gravis, 786 neurophysiology, 781 neurotoxic fish poisoning, 787–788 physical examination, 779–780 PM/DM, 788 prophylaxis and maintenance, 783 respiratory testing, 781 symptomatic care, 783 synthesis, 781–782 tetanus, 788 975 tick paralysis, 787 tissue testing, 781 ventilation and airway protection, 782–783 workforce, 22–23 Intermittent mandatory ventilation (IMV), 18 Intermittent pneumatic compression devices (IPC), 346 Internal carotid artery (ICA), 694 International surgical trial in intracerebral haemorrhage (STICH), 568 Intoxication cocaine/sympathomimetics, 531–532 GHB, 532 lysergic acid diethylamide, 532 narcotics, 532 sedatives, 531 Intracerebral hemorrhage (ICH), 267, 323 cerebral blood flow, 246 cerebral edema, 247 clinical outcome, 246 clinical presentation, 567–568 diagnostics imaging technique computed tomographic angiography, 569 computed tomography, 568–569 DSA, 570–571 MRI, 570 patient evaluation, 571 stages, 568 epidemiology, 566 INTERACT, 246 intracranial pressure, 247 medical management blood pressure, 571, 572 cerebral edema, 571 general care, 572 hematoma expansion and rebleeding, 571 seizures, 572 morbidity and mortality, 568 peri-hematomal edema, 748 primary/secondary, 565–566 risk factor, 749 age, 566 antithrombotic medications, 567 CAA, 567 hypertension, 567 race/ethnicity, 566–567 surgical management cerebellar hemorrhage, 573–574 hydrocephalus, 574 IVH, 574 supratentorial hemorrhage, 572–573 treatment of, 566 Intracranial hemorrhage, 837–839 Intracranial pressure (ICP), 242, 267, 284, 682 adverse effect, 128 autoregulation and cerebral energy requirements CBF, 733 CMRO2, 732 CPP, 733–734 lactate/pyruvate ratios, 733 MAP, 732, 733 barbiturates, 597 BBB, 730 brain tissue oxygenation, 735 CBF, 735 cerebral edema cytotoxic (cellular) edema, 731 interstitial edema, 731 976 Intracranial pressure (ICP) (cont.) osmotic edema, 731 vasogenic edema, 730 coma and herniation syndromes central herniation, 731 uncal herniation, 731–732 upward herniation, 732 compliance, 732 cranial vault bifrontal craniectomy, 740 DHC and duraplasty, 739–740 mass lesions, evacuation of, 739 CSF, 733 definition, 580–581 EEG, 735 glucose control, 739 hemodynamic monitoring, 735 hyperventilation, 596 hypothermia, 596 ICP waveforms, 732 indications aSAH, 734 traumatic brain injury, 734 monitoring, 594–595 indications, 129–130 intraparenchymal devices, 130–131 uses of, 130 ventricular catheter, 130 osmotherapy hypertonic saline, 595 mannitol vs HTS, 595–596 serum osmolality and sodium, 595 paralysis, 596 prognosis, 734 reduce cerebral edema osmotic agents, 736–737 steroids, 737 reduce cerebral metabolism barbiturates, 737 hypothermia, 737 seizure treatment and prophylaxis, 737 reduce CSF volume and CBV cerebrospinal fluid drainage, 736 hyperventilation, 736 positioning, 736 resuscitation, 736–735 sedation/neuromuscular blockade, 738–739 steroid, 597 stimulation, 738 surgical decompression acute subdural hematoma, 596 epidural hematoma, 596 posterior fossa lesions, 597 traumatic parenchymal hemorrhage, 596–597 techniques fluid-coupled monitoring/ventriculostomy, 734–735 parenchymal monitoring, 735 temperature control, 739 treatment brain multimodality monitoring, 131–132 compliance assessment, 132 continuous multimodality monitoring, 132–133 duration, 131 goal-directed therapy, 131 management, 131 waveform, 132 Index Intracranial vascular procedure, 202 Intraoperative Hypothermia for Aneurysm Surgery Trial (IHAST), 845, 852, 859 Intraoperative neuroanesthesia anesthesia and neuropathophysiology arterial oxygen content, 847 cerebral blood flow, 845–847 cerebral oxygen consumption, 844–845 fluid and electrolyte management, 847–848 intracranial pressure, 845 craniotomy, 857 esmolol dose, 848 extubation logistics, 857–858 patient positioning, 848 perioperative care brainstem, 850 posterior fossa surgery, 850 transphenoidal hypophysectomy, 850–851 tumors, 849–850 venous air embolism, 849 visual loss, 848–849 spine surgery, 856–857 stroke, 855–856 timing and communication, 848 vascular neurosurgery arteriovenous malformations, 852, 854 carotid endarterectomy, 854 cerebral aneurysms, 851–852 endovascular, 854–855 Intravenous immunoglobulin (IVIg), 785 Intraventricular hemorrhage (IVH), 336–337 Invasive intracranial monitoring brain oxygenation jugular venous oximetry, 133–134 tissue oxygen, 134–136 cerebral blood flow bioinformatics, 139–140 cerebral perfusion, 138 classification, 138 laser Doppler flowmetry, 138 metabolism measurement, 137–138 thermal diffusion, 139 cerebral microdialysis clinical application, 136–137 definition, 136 lactate classification, 137 molecule measurements, 137 principles, 136 threshold values, 137 ICP (see Intracranial pressure [ICP]) multimodality monitoring, 127 pathophysiology autoregulation and cerebral perfusion pressure, 129 Monro-Kellie doctrine and compliance, 129 secondary brain injury, 127 Ion channel disease, 276 Ischemic stroke, 301 Isocitrate dehydrogenase-1 (IDH1), 712 J Jugular venous oximetry, 122–123, 133–134 K Kluver–Bucy syndrome, 76 Kussmaul sign/hepatujugular reflux, 523 Index L Labetalol, 245 Lambert-Eaton myasthenic syndrome (LEMS), 786–787 Laryngeal mask airway (LMA) contraindications to, 197 disadvantages of, 57 ETT, 197–198 pre-hospital airway management, 197 ProSealr, 197 Laryngoscopy blade selection bougie, 183 curved, 183 DL vs VL, 184 ETT counterclockwise rotation, 183 straight, 183 optimal external laryngeal manipulation (OELM), 182, 183 patient positioning, 182–183 video laryngoscopy Airtraq®, 184, 185 blades shapes, 184 Clarus® Levitan optical airway scope, 184, 186 vs conventional laryngoscopy, 185 device cost, 184 ETT exchange, 186 GlideScope®, 184, 185 glottic view, 186, 187 Storz C-MAC®, 184, 185 Laser Doppler flowmetry (LDF), 122, 138 Laxatives, 375 Length of stay (LOS), 281 Leukocytosis, 334 Leukopenia bone marrow aplasia, 328 immune and drug-related granulocytopenia, 328–329 primary bone marrow disease acute respiratory distress syndrome (ARDS), 328 antibiotic regimens, 327–328 fungal infections, 328 septic shock, 327 white blood cell count in, 327 Levetiracetam, 805 Lewy-body dementia (LBD), 272 Life-sustaining treatment (LST) advance directive CPR, 932–933 durable power of attorney, 928 empirical study, 932 goal of, 932 life decision chart, 928 limitation of, 929 patient instructions, 927 physician form, 929–931 physician’s role, 933 substituted judgment, 932 surrogate/proxy healthcare, 927 terminal illness, 933 artificial nutrition and hydration, 936–937 aspects of, 927 cardiac implanted electronic devices, 927 dialysis, 927 DNR order, 926 implantable cardio-defibrillator device, 927 mechanical ventilation, 926 medical futility APACHE, 935 city-wide process, 935 977 imminent demise futility, 935 lethal condition futility, 935 outcomes, 935 patient autonomy, 934 patient’s quality, 934 physiological effect, 935 quantitative and qualitative futility, 934 Schneiderman’s original definition, 935 with organ donation, 924–925 palliative sedation, 938 perioperative DNR Status, 933–934 physician aid, 937–938 refuses, 926 voluntary dehydration, 938 without organ donation, 925–926 Lithium, 313 Liver, 804 LMWHs See Low-molecular-weight heparins (LMWHs) Low grade gliomas (LGGs), 716–717 Low-molecular-weight heparins (LMWHs), 345, 347, 957 Luteinizing hormone releasing hormone (LHRH), 295 Lyme disease diagnosis of, 499 pathogenesis clinical manifestations, 497–498 CSF analysis, 498 EEG and CT abnormalities, 498 intermittent tingling and paresthesia, 499 laboratory and radiographic signs, 498–499 meningitis, 498 psychological testing, 498 radicular pain and sensory changes, 499 third stage, 498 treatment, 499–500 Lymphocytic choriomeningitis virus (LCMV) meningitis, 451 Lysergic acid diethylamide (LSD), 532 M Magnetic resonance angiography (MRA), 825, 827, 828 Magnetic resonance imaging (MRI), 697, 758 angiography and venography, 825, 827, 828 cerebral vasospasm, 551 DWI, 824, 826 echo-planar sequence, 822, 824 fast spin echo/turbo spin echo, 820 gradient-recalled echo sequence, 821, 823–825 ICH, 570 intravenous contrast material, 821–822 intravenous gadolinium contrast agent, 828–829 inversion recovery, 820–821, 823 magnetic field, 818 MR perfusion, 824, 827 neurorehabilitation, 883–884 pediatrics, 606 proton and radiofrequency, 818 repetition time, 819–820 spatial localization, 820 spin echo and sequences, 819, 820 T1 relaxation and T1-weighted contrast, 818–819 T2 relaxation and T2-weighted contrast, 819, 821, 822 usage restrictions, 825, 827–828 Magnetic resonance venography (MRV), 825, 827, 828 Mask ventilation facemask sealing, 179 lower esophageal sphincter (LES), 180 978 Mask ventilation (cont.) pressure manometer addition, 180 sniffing position, 179 Maximum expiratory pressure (MEP), 782 Maximum inspiratory pressure (MIP), 782 Mean arterial pressure (MAP), 845–846 Mean transit time (MTT), 696 Mechanical ventilation (MV) complications of VAP, 46–48 VIDD, 48–49 VILI (see Ventilator-induced lung injury [VILI]) conventional ventilation ACV, 17–18 CMV, 17 control and support modes, 16 dual control ventilation, 22–23 IMV, 18–19 PSV, 19–21 SIMV, 19 hypoxemia, 29–31 mode of ventilation APRV, 23–24 HFOV, 24 NAVA, 25 NIV, 26–28 PAV, 25–26 NPV, 13 oxygenation adjunctive and rescue therapy, hypoxemia, 34–36 hypoxia, 29–31 PEEP, 32 recruitment maneuvers (RM), 33 shear trauma, 32 PEEP, 16 PPV, 13–15 respiratory system (RS) physiology definition, distribution of, driving pressure, dysfunction, 12 function of, 67 gas exchange, 11–12 gravitational and non-gravitational forces, lung compliance, lung volume, minute ventilation (VE) and dead space, 7–8 ventilation distribution, 9–11 volume vs pressure control, 15–16 weaning modes, 39 predictors, 38–39 SBT, 39–42 Melanoma metastasis, 819, 820 Meningioma, 720, 721, 724 Meningitis, 534 bacterial (see Bacterial meningitis) diagnosis of, 304 fungal, 473 management of, 304 retrospective study, 304 viral (see Viral meningitis and encephalitis) Metabolic encephalopathy, 421 Millard-Gubler syndrome, 78 Minimally conscious state (MCS), 880 Modified Ashworth Scale (MAS), 676, 677 Index Monro-Kellie doctrine states, 129 Motor evoked potentials (MEPs), 116 Motor function coordination tests, 72 extrapyramidal disorders, 72 lower motor neuron disorders, 72, 76 motor homunculus, 71, 74 neuromuscular junction disease, 72 polymyositis, 72 upper motor neuron disorders, 71–72, 75 Multiprofessional team cost differential, 25 discharge disposition, 24 knowledge-based and United Council, 24, 25 multivariate analysis, 26 NCS, 27 neurocritical care team, 26 online survey, 27 patient outcome, 27 protocol-driven therapy, 27 quality issues, 22 Multi-system atrophy (MSA), 272 MV See Mechanical ventilation (MV) Myasthenia gravis (MG), 269 Mycobacterium tuberculous infections spinal tuberculosis, 472–473 tuberculoma, 471–472 tuberculous meningitis clinical presentation, 468–469 diagnosis, 469–470 vs HIV infection, 467–468 pathogenesis, 468 prognosis and sequelae, 471 treatment, 470–471 Myeloproliferative disorders (MPD), 332 Myoclonic status epilepticus (MSE), 761–762 N National Cancer Institute of Canada (NCIC), 716 National Institute of Health (NIH), National Institute of Heath Stroke Scale (NIHSS), 696, 697 National quality forum (NQF), 12 Near-infrared spectroscopy (NIRS), 767 Nervous system bilateral bitemporal field cut, 83 brain (see Brain) central cord syndrome, 85 neurological examination cranial nerves (see Cranial nerves) mental status, 66, 67 motor function, 71–72, 74–76 reflexes, 72–73 sensation, 73, 75, 77–80 Parinaud’s syndrome, 78 right central seventh nerve paralysis, 81 right sided decrebration, 82 Tinel’s sign, 87 trigeminal neuralgia, 86 vitamin B12 deficiency, 86 Neurally adjusted ventilatory assist (NAVA), 25 Neuroanatomy adult central nervous system, 34 brainstem medulla, 53, 54 midbrain, 40, 44, 48, 53–55, 57 Index pons, 53, 54, 56, 57 pontomedullary sulcus, 53, 54 reticular formation, 54–55 cerebellum biological functions, 56 flocculonodular lobule, 57 made up of, 55 petrosal surface, 53, 55, 59 suboccipital surface, 55–57, 59–60 surfaces of, 57 tentorial surface, 55, 59 tent-shaped midline structure, 57–58 vermis, 56 cerebrum (see Cerebrum) nervous system (see Nervous system) neuropathology (see Neuropathology) posterior fossa, 52, 54 Neurocritical Care Society (NCS), 27 Neurocysticercosis clinical manifestations, 489–490 clinical presentations, 490 human infection, 489 symptomatic, 489 treatment, 490–492 in United States, 489 Neurogenic bladder acute and subacute period, 676, 677 arreflexic/lower motor bladder, 675 monitoring, 675 parasympathetic stimulation, 674 respiratory complication, 674 somatic stimulation, 674–675 spastic/upper motor bladder, 675 ureterovesical junction, 674 urologic complication, 674 Neurogenic bowel Auerbach’s/Meissner’s plexus, 675 bowel program, 675, 676 flaccid/lower motor neuron bowel, 676 prevalence, 676 reflexic/upper motor neuron, 676 Neurogenic stress cardiomyopathy (NSC), 557 Neurological examination basal ganglia examination, 528–529 cerebellar examination, 529 cranial nerve ARAS fiber, 525 blown pupil, 526 CNS lesion, 525 corneal reflex, 527 “doll’s eyes” maneuver, 527 Edinger-Westphal nucleus, 526 gag reflex, 527 Horner’s syndrome, 526 imaging technique, 526 oculomotor function, 526 pupillary response, 525 syphilis, 527 transtentorial herniation syndrome, 526 vestibulo-ocular reflex, 527 funduscopic examination, 528 GCS, 524–525 hemispatial/hemibody attention, 525 higher cortical function, 525 motor, 528 reflex examination, 529 sensation, 529 979 Neuromuscular antagonist acetylcholine, 951 succinylcholine, 950–951 Neuromuscular disorders (NMDs) ICU-acquired weakness clinical presentation, 790 diagnosis, 790 electrophysiology, 790 genetic testing, 796 imaging, 795 laboratory testing, 794–795 management, 790 neurophysiology, 795–796 respiratory testing, 795 risk factors, 790 signs, 792–794 symptoms, 790–792 tissue testing, 796 pathophysiology axolemma, 778 axonal degeneration, 778 axoplasmic transport, 778 caliber fibers, 778 lower motor neurons, 778, 779 poliomyelitis, 779 segmental demyelination, 778 upper motor neuron, 778, 779 Wallerian degeneration, 778 weak patients acute poliomyelitis, 784 acute porphyria, 785 blood gases, 782 botulism, 787 circulation, 782–783 clinical judgment, 782 diphtheria, 788 discharge planning, 788, 789 GBS, 784 history, 779 hypokalemic periodic paralysis, 788 LEMS, 786–787 lung function testing, 782 myasthenia gravis, 786 neurotoxic fish poisoning, 787–788 physical examination, 779–780 PM/DM, 788 prophylaxis and maintenance, 783 symptomatic care, 783 synthesis, 781–782 testing, 780–781 tetanus, 788 tick paralysis, 787 ventilation and airway protection, 782–783 Neuromyelitis optica (NMO), 102 Neuropathology aneurysms berry, 98 circle of Willis, 98 definition of, 98 fusiform, 98 infective/mycotic aneurysms, 98 saccular, 98 blood-brain barrier, 92–93 brain tumors diffuse astrocytomas, 99 glioblastoma, 99–100 gliomas, 99 980 Neuropathology (cont.) medulloblastoma, 101 meningiomas, 100–101 metastatic tumors, 101 oligodendrogliomas, 100 schwannomas, 101 central nervous system acute purulent (bacterial) meningitis, 102 astrocytes, 92 axoplasmic constituents, 92 brain abscesses, 102 Creutzfelt-Jacob disease (CJD), 103 cytoplasmic swelling, 90 ependyma and choroid plexus, 92 focal/diffuse hypoxia/ischemia, 90 immunocompromised host, 102–103 microglia, 92 oligodendrocytes, 92 synaptophysin, 90 cerebral edema, 93 cerebral herniation, 93–94 cerebrovascular disease CADASIL, 98 cerebral amyloid angiopathy (CAA), 97–98 global hypoxia/ischemia, 97 ischemic infarcts, 97 ischemic strokes, 97 multi-infarct dementia, 97 posterior reversible encephalopathy syndrome (PRES), 97 regional ischemic injury, 97 systemic hypertension, 97 venous thrombosis, 97 demyelinating conditions, 101–102 hydrocephalus, 93–94 neurodegenerative disease, 104 toxic metabolic diseases, 103–104 traumatic brain injury (TBI) amyloid precursor protein, 95 chronic traumatic encephalopathy, 95 closed head injury, 94 contusion/laceration injury, 95 coup contusions, 95 diffuse axonal injury (DAI), 95 epidural hemorrhage, 95 primary damage, 94 secondary damage, 94 subdural hemorrhage, 95 traumatic intracranial hemorrhage, 95 traumatic spinal cord injury, 96 vascular/meningeal tearing, 96 vascular malformation arteriovenous malformations (AVMs), 98–99 capillary telangiectases, 99 cavernous angiomas, 99 venous angiomas, 99 Neuroradiological imaging baseline ventricular size, 837 brain tumors, 839–841 cerebral venous thrombosis, 834–835 computed tomography angiography and perfusion, 829–830 clinical application, 829 intravenous contrast agent, 829 hypoxia and metabolic insufficiency, 835–836 intracranial hemorrhage, 837–839 Index MRI (see Magnetic resonance imaging [MRI]) oligemia, stroke and dural sinus thrombosis, 834, 835 seizure disorder, 836–837 Neurorehabilitation brain-injured patient care caregiver, 887 neuropsychological treatment, 888 patient assessment, 887–888 computed tomography, 883 DOC coma, 879 Klüver-Bucy syndrome, 881 minimally conscious state, 880 Parkinsonian and cerebellar symptoms, 881–882 pathological postures, 881 posttraumatic mutism, 882 posttraumatic psychomotor agitation, 880–881 severe brain injury, 880 vegetative state, 879–880 electroencephalogram, 882 fiberoptic rhinolaryngoscopy, 886 hydrotherapy, 885–886 mismatch negativity and P300, 883 MRI, 883–884 neuroimaging, 883 occupational therapy, 886 pharmacotherapy, 886–887 positron emission tomography, 884 protocols, 884–885 single photon emission computed tomography, 884 somatosensory evoked potential, 882–883 stroke rehabilitation, 887 swallowing, 886 transcranial Doppler, 884 urological rehabilitation, 886 Neurosyphilis general paresis and tabes dorsalis, 495 incidence, 494 serologic testing CSF-VDRL test, 496 nontreponemal tests, 496 treponemal tests, 495–496 venereal disease research laboratory, 495–496 stroke, 494–495 syphilitic gummas, 495 syphilitic meningitis, 494 treatment, 497 Neutropenia acute respiratory distress syndrome, 328 bone marrow aplasia, 328 colony-stimulating factors, 328 fungal infections, 328 galactomannan antigen test, 328 immune and drug-related, 328–329 prophylactic antibiotics, 328 white blood cell count in, 327 Nicardipine, 245 NIHSS See National Institute of Heath Stroke Scale (NIHSS) Nimodipine, 248 Nonconvulsive status epilepticus (NCSE), 535, 761 clinical significance and management, 801 seizures, 761 Non-invasive mechanical ventilation (NIV), 26–28 Noninvasive monitoring modalities application, 110 Index cerebral blood flow cerebral ischemia, 116–117 indicator dilution method, 117 laser Doppler flowmetry, 122 transcranial Doppler (see Transcranial Doppler [TCD]) neurological function brain death, 111 electroencephalography (see Electroencephalography [EEG]) evoked electrical activity, 115–116 level of consciousness, 110–111 limitation of, 110 uses, 110 oxygen supply/demand balance cerebral oximetry, 123 jugular venous oximetry, 122–123 oxygen partial pressure, 122 tissue probes, 123–124 Nonsteroidal anti-inflammatory drugs (NSAIDs), 949–950 Norepinephrine, 250 Nurse practitioners (NPs), Nutrition assessment of screening, 396–397 stress, 397 complication cellular dehydration, 404 fatal metabolic, 404 fat overload syndrome, 404 hypercapnia, 404 hyperglycemia, 404 critical illness, immunonutrition arginine, 395–396 dietary RNA, 396 glutamine, 395 initiating nutritional support, 399–400 malnutrition, 392 monitoring status, 402 neuroICU patient, 402–404 nutrient administration enteral feeding, 400–401 enteral vs parenteral, 402 immune function, 402 intestinal barrier function, 400 parenteral, 401 obese patient, 404 requirement caloric need calculation, 397–398 carbohydrates, 398–399 lipids, 399 micronutrients, 399 polysaccharides, 398–399 protein, 399–400 starvation (see Starvation) O Obstetrics and gynecology (OB/GYN), 21 Oligemia, 834, 835 Opioids, 285, 288, 312 Oral anticoagulation (OAC) therapy, 580 Organ donation after cardiac death, 914 consent for decoupling, 905 designated requestors, 904 981 family characteristics, 904–905 IOM recommendations, 905 OPO, 904 medical management algorithmic approach, 907, 908 central venous pressure (CVP), 909 donor lung ventilator, 912 excessive fluid resuscitation, 910 goals, 906–907 hemodynamic and cardiovascular, 905–906 hemodynamic instability, differential diagnosis of, 909 HRT use, 911 intensivist-led donor management program, 906 low-dose dobutamine stress tests, 908 PAC, 908 pulmonary artery pressure, 912 pulmonary function, 911–912 respiratory status, 911 transesophageal echocardiography (TEE), 907 transthoracic echocardiography (TTE), 907 vasodilatation, 909 vasopressors, 910–911 supportive care, 913–914 Organ dysfunction cardiovascular altered cerebral autoregulation, 418 cardiac arrest, 417 endocarditis, 417 hypertensive crisis, 418 endocrine, 421 liver acute liver failure, 419–420 hepatic encephalopathy, 420 metabolic encephalopathy, 421 renal dialysis disequilibrium syndrome, 421 uremic encephalopathy, 421 respiratory hypoxia and hypercapnia, 418 sepsis associated encephalopathy, 419 sickness behavior syndrome, 418–419 Orthostatic hypotension, 671–672 Oxytocin, 295 P Parasitic infections, CNS amoebic meningoencephalitis, 489 cerebral malaria pathogenesis, 487–488 treatment, 488–489 echinococcal disease, 492–493 neurocysticercosis clinical manifestations, 489–490 clinical presentations, 490 human infection, 489 symptomatic, 489 treatment, 490–492 in United States, 489 strongyloidiasis, 493 toxocariasis, 493–494 Parinaud’s syndrome, 78 Parkinson disease (PD), 272 Paroxysmal nocturnal hemoglobinuria, 327 982 Patient safety indicators (PSIs), 11 Pediatric neurocritical care blood loss, 689 brain death, 690 CBF, 683 CSW, 687 developmental considerations, 682 DI, 687–688 hemodynamic physiology, 682–683 intraoperative anesthetic drugs and agents, 683 perioperative intravenous fluids acute hyponatremia, 686 glucose/no glucose, 688–689 normal saline, 684 OW and OS, 684 urine tonicity, 686 postoperative neurocritical care, 683 postoperative renal salt and water handling, 686 postoperative sedation and pain management, 689 seizures and status epilepticus, 689–690 SIADH secretion, 686–687 Pediatric trauma See Traumatic brain injury (TBI), pediatrics Pentamidine, 313 Perfusion, neuroradiological imaging, 829–830 Peripheral parenteral nutrition (PPN), 401 Periventricular demyelination, 101 Pharmacotherapy brain and central nervous system effect of, 944–945 routes of administration, 945 critical care pharmacist, 959 miscellaneous agent conivaptan and tolvaptan, 957–958 desmopressin, 957 intravenous immunoglobulin, 958 magnesium, 959 nimodipine, 958–959 statins, 959 neurorehabilitation, 886–887 pharmacokinetics context-sensitive halftime, 943 distribution, 942 elimination, 942–943 metabolism, 942 route of administration, 942 steady-state level, 943–944 Phenobarbital, 374 Phenytoin, 374, 805 Physician assistants (PAs), Physician quality reporting initiative (PQRI), 14 Physician quality reporting system (PQRS), 14 PICA See Posterior inferior cerebellar artery (PICA) Pituitary adenoma, 850 Polycythemia vera (PV), 333 PONV See Postoperative nausea and vomiting (PONV) Positive end-expiratory pressure (PEEP), 16 Positive pressure ventilation (PPV), 13–15 Posterior inferior cerebellar artery (PICA), 58, 60–61 Posterior reversible encephalopathy syndrome (PRES), 267, 381, 533, 695 Postoperative complications anaphylactic allergy, 866–867 anterior cervical discectomy and fusion, 865 arterial hemorrhage, 875 bifrontal craniotomy, 868 Index brachial plexus injury, 874 cerebral hyperemia, 871 craniopharyngioma, 872 Dupuytren’s contracture, 866 failed back syndrome, 865–866 flaccid paralysis and apnea, 871 hypoglycemia, 865 hypothermia, 869 intracerebral hemorrhage/ischemia, 868 myocardial infarction, 875 neuromuscular blockade, 870 periorbital edema, 873 PONV, 864 postoperative visual loss, 873–874 pupil, 870–871 respiratory failure, 876 seizure, 867, 869 stroke, 870 subarachnoid hemorrhage, 871–872 tumor excision, 868–869 Postoperative nausea and vomiting (PONV), 864 Posttransfusion pupura, 330 Post-traumatic seizures (PTS), 802 Potassium homeostasis hyperkalemia, 371–372 hypokalemia, 372–373 renal excretion, 371 transcellular shift, 371 Praziquantel, 492 Prehospital care system central nervous system injury airway, 158 breathing, 158 circulation, 158 disability and destination, 158–159 head injury, 157–158 hyperbaric oxygen, 159 hyperventilation, 159 hypoglycemia, 159 pediatric considerations, 159 EMS, 150–151 hypothermia application, 156–157 complications of, 155–156 induction, 154–155 maintenance of, 155 rewarming, 155 subarachnoid hemorrhage, 157 targeted temperature management, 154 traumatic brain injury, 157 resuscitation and 2010 AHA guidelines ACLS, 151 adult and pediatric, 151–152 advanced cardiac life support, 152–153 airway management, 152 cardiopulmonary resuscitation, 154 ethical care, 151 neonatal resuscitation, 153–154 pediatric advanced life support, 153 spinal cord injury clinical evalution, 159–160 complicating care, 160 cricoid pressure, 160 negative inspiratory force, 160 neurological evaluation, 162 Index stroke Cincinnati Prehospital Stroke Scale, 161 clinical observation, 161–162 Los Angeles Motor Score, 161, 162 transport of patients, 161 treatment of, 162 PRES See Posterior reversible encephalopathy syndrome (PRES) Pressure-regulated volume control (PRVC), 22–23 Pressure support ventilation (PSV), 20–21 Primitive neuroectodermal tumors (PNETs), 720 Progressive multifocal leukoencephalopathy (PML), 102, 503–505 Progressive supranucelar palsy (PSP), 275 Prolactin (PRL), 295 Propofol, 284–285, 287 Propofol infusion syndrome (PRIS), 283 Propofol-related infusion syndrome (PRIS), 384 Proportional assist ventilation (PAV), 25–26 Prosopagnosia, 78 Prothrombin complex concentrates (PCCs), 580 Pseudothrombocytopenia, 330 Pulmonary embolism (PE) diagnosis, 349 massive and submassive, 349 treatment, 350 Pulmonary oxygen toxicity (POT), 44 Q Quality improvement AANS, 12 complex medical information, 10 evaluation of, 12 future aspects, 16 Institute of Medicine, 10–11 medical errors, 10 in medicine, 14 mortality and length of stay, 13 in neuroICU communication, 16 DVT prophylaxis, 14–15 handoffs, 16 hospital-acquired complications, 15 national quality initiatives, 15 single institution quality project, 15–16 NQF, 12 PSIs, 11 QIs, 11 stakeholder, 12 UHC, 12 Quality indicators (QIs), 11 R Radiation therapy, 713–714 Radiographic imaging artery aneurysm, lateral view, 583, 585 catheter angiography, 583, 584 imaging modality, 583 intraparenchymal hemorrhage, 583 intraventricular hemorrhage, 583, 584 ischemic vs hemorrhagic stroke, 583 subarachnoid hemorrhage, 583, 584 RBC transfusions (RBCT), 323 μ-receptor, 285 Recursive partitioning analysis (RPA), 712 983 Reduction of cerebral metabolism of O2 (CMRO2), 282 Regional wall motion abnormalities (RWMA), 556 Renal replacement therapy acute brain injury patient critical aspects of, 386 intermittent vs CRRT, 386–387 indications for, 385–386 modalities of, 386 Respiratory complication, 671–672 Respiratory pattern apneustic breathing, 523 ataxic breathing, 524 Biot’s respirations, 524 Cheyne-stokes respirations, 524 Kussmaul respirations, 524 persistent hyperventilation, 523 Respiratory system (RS) physiology definition, driving pressure, dysfunction, 12 function of, 67 gas exchange, 11 gravitational and non-gravitational forces, lung compliance, lung volume, minute ventilation (VE), ventilation and perfusion relationships, 9–11 ventilation distribution, ventilation perfusion, Response Assessment in Neuro-Oncology (RANO), 713 Rickettsial disease, 500–501 Rocky Mountain spotted fever rash, 437–438, 500–501 S SCA See Superior cerebellar artery (SCA) SCI See Spinal cord injury (SCI) Secondary brain injury (SBI), 127 Sedation and analgesia (S&A) acute phase and subacute phase, 289 barbiturates, 287 benzodiazepines, 285–286 delirium, 288–289 DEX, 286–287 ketamine, 286 LOS, 281 monitoring sedation, 288 opioids, 285 pharmacokinetic parameters, 282 principle of CBF, 283–284 CMRO2, 282 ICP, 284 seizures, 284 propofol, 284–285 side effects of benzodiazepine, 287–288 dexmedetomidine, 288 opioids, 288 propofol, 287 Seizures, 446, 749–750 AEDs benzodiazepines, 809 epilepsy surgery, 810–811 phenytoin and fosphenytoin, 809 status epilepticus, 810 984 Seizures (cont.) causes, 803–804 clinical findings, 802 EEG epileptiform, 801 indications, 800 NCSE, 800, 801 intoxication nonrecreational drug-induced seizures, 807–808 recreational drug-induced seizures, 808 malignancy, 803 metabolic disorders glucose metabolism, 806 hepatic encephalopathy, 807 hypocalcemia, 806 hypomagnesemia, 806 hyponatremia, 805–806 hypoparathyroidism, 806 hypophosphatemia, 806 uremia, 806–807 PTS, 802 transplantation bone marrow, 804–805 liver, 804 lung, 804 and vascular lesions stroke, 803 subarachnoid hemorrhage, 802–803 vasculitis, 803 Selegiline, 275 Sensation dermatome, 75, 79 pain and temperature, 73, 77, 78 peripheral nerves, 75, 80 touch and proprioception, 73, 75 Sepsis associated encephalopathy, 419 Sickle cell disease (SCD) cerebral ischemia, 324 clinical features, 324 complications of, 325 treatment of, 324–325 Sickness behavior syndrome, 418–419 Society of critical care medicine (SCCM), 20, 286 Sodium plasma concentration determinant of, 356 disorders of, 356 serum osmolality, 357 total body water (TBW), 356 Somatosensory evoked potentials (SSEPs), 116, 766, 882–883 Somatostatin (SS), 295 Spasticity, 676, 677 Spastic/upper motor bladder, 675 Spetzler-Martin grading system, 585 Spinal cord injury (SCI), 251, 750 autonomic dysreflexia, 269 bradydysrhythmias, 269 cardiac sympathetic chain, 268 causes of death, 268 classification of, 668–669 craniocervical junction atlanto-occipital dislocation, 624, 625 cock robin head appearance, 625 Down’s syndrome, 625 Grisel’s syndrome, 625 Jefferson fracture, 624, 626 Index odontoid fractures, 625, 626 rheumatoid arthritis, 625 traumatic fracture, 625–626 epidemiology, 619–620 imaging CT and MRI, 623–624 radiographic assessment, 623 management and evaluation aggressive volume resuscitation, 620–621 ATLS protocol, 620 emergent intubation, 620 forced vital capacity, 620 Glasgow Coma Scale score, 620 Swan-Ganz catheter monitoring, 620–621 vasopressor, 620–621 medical management of diaphragm stimulator placement, 630 DVT prophylaxis, 632–633 genitourinary complication, 633 multisystem implications, 629 norepinephrine, 631 organism identification, 630 phenylephrine, 631 respiratory complications, 629, 630 tracheostomy, 630 venous thromboembolic disease, 632 ventilator weaning strategy, 630 neurologic examination anterior cord syndrome, 622 ASIA grade, 621, 622 Brown-Sequard cord syndrome, 622 central cord syndrome, 621–622 “log-rolling” patient, 621 motor score, 621 posterior cord syndrome, 622 sensory score, 621 outcomes, 669–670 patient recovery, 673 patient rehabilitation autonomic dysreflexia, 673–674 bladder (see Neurogenic bladder) bowel (see Neurogenic bowel) contraction and edema, 670–671 heterotopic ossification, 677–678 orthostatic hypotension, 671–672 pain, 676–677 pressure ulcers, 672–673 psychological adjustment, 678 respiratory complication, 671–672 spasticity, 676, 677 pharmacologic agents, role, 633–635 sensorimotor deficit, 268 subaxial cervical spine injury compression fractures, 626 flexion teardrop fractures, 626, 627 inferior articulating process, 626, 627 perched, jumped/locked facets, 627, 628 surgical treatment of neurologic deterioration/optimizing potential, 635 prospective pilot study, 635 spinal column injury treatment, 636–637 surgical decompression, 636 traumatic spinal cord compression, 635 survival rate and prevalence, 668 tachydysrhythmias, 268 Index thoracolumbar injury burst fractures, 628, 630–631 chance fractures, 628 compression fractures, 628 Denis system, 627 fracture-dislocation types, 628, 632 gunshot wound, 628 Spinal deformity advantage of, 662–663 aggressive technique, 662, 663 closing wedge osteotomy, 662 complication, 663–664 consciousness, 659 definition, 659 first line therapy, 661 flat-back syndrome, 661 polysegmental osteotomy, 662 progressive muscle fatigue, 659 pseudarthrosis, 661 salvage spine surgical technique, 661 Smith–Petersen osteotomy technique, 662 surgical modality, 661 thoraco-lumbar/lumbar curve, 661 Spinal epidural abscess clinical features and diagnostic considerations, 462 incidence, 461 microbiology of, 462 pathophysiology, 461–462 risk factors, 462 treatment, 462–463 Spinal infection anterior approach, 654, 657 posterior approach, 652, 654 single stage, 654–656, 658 two stage, 658 Spinal instrumentation anterior cervical instrumentation, 648 intervertebral cages, 648–649 thoracic instrumentation, 648 optimal biomechanical force, 647 posterior Harrington distraction rod, 647 hook rod system, 647 Luque instrumentation, 647 pedicle screw, 647–648 sacro-pelvic instrumentation, 649 Spinal neoplasm acute deterioration, 658 Harrington classification, 658 indications, 658 local lesions, 658 multi-modal treatment, 658 patient outcomes, 658 prognosis, 659 rostral-caudal effect, 659 spill tumor, 659 spinal instability/neurologic impairment, 658 spondylectomy/vertebrectomy, 659, 660 structural integrity, 658, 659 Spinal shock syndrome, 528 Spinal trauma atlanto-axial fracture interposed odontoid process, 650 transarticular screw fixation, 650 985 ventral technique, 650–651 wiring/graft-wiring technique, 650 subaxial cervical facet dislocation, 651 thoracic and lumbar fracture biomechanical characteristics, 651 bony/ligamentous structures, 651 Denis classification, 651 flexion-distraction injury, 651 hook rod construct, 652 indication, 651 pedicle screw rod, 652, 653 primary load bearing, 651 Spinal tuberculosis, 472–473 Spine surgery, 856–857 Spontaneous breathing tests (SBT), 40–41 Starvation immune effects and infection rates, 393–394 metabolic response catecholamine levels, 392 peripheral conversion, 392 organ function hypermetabolism-multiple organ failure (HOF), 393 mortality rates, 393 multiple system organ failure (MSOF), 393 stress effects, 397 wound healing, 394–395 Status epilepticus (SE), 270 Stroke, 301 AF, 265 beta-blockers, 267 cardiac monitoring, 267 CK-MB, 263 feline model, 264 intraoperative neuroanesthesia, 855–856 murine model, 264 myocardial infarct, 265 neuroradiological imaging, 834, 835 neurorehabilitation, 887 patients recurrence, 265 prehospital care system Cincinnati Prehospital Stroke Scale, 161 clinical observation, 161–162 Los Angeles Motor Score, 161, 162 transport of patients, 161 treatment of, 162 Strongyloidiasis, 493 Study of treatment of acute hypertension (STAT), 242 Subacute sclerosing panencephalitis (SSPE), 503 Subarachnoid hemorrhage (SAH), 301, 323, 533, 839 catecholamine hypothesis, 263 CBN, 263 genetic polymorphisms, 262 hypertensive normovolemic therapy, 249 poor grade, 248 prehospital care system, 157 rebleeding prevention, 247–248 systolic dysfunction and function, 262 Subdural hematoma, 831 Sudden unexpected death in epilepsy (SUDEP), 272 Superficial VTE, 351 Superior cerebellar artery (SCA), 56–58, 62 Sustained low-efficiency dialysis (SLED), 386 Synchronized Intermittent Mandatory Ventilation (SIMV), 19 986 Syndrome of inappropriate antidiuretic hormone (SIADH), 363, 581, 686–687, 808 Synucleinopathies amantadine, 275 dopamine, 275 LBD, 273 L-dopa treatment, 274 MSA, 274 parkinson disease cell loss, 273 vs orthostatic hypotension, 274 in vivo, 273 selegiline, 275 Syphilis categories, 494 neurosyphilis general paresis and tabes dorsalis, 495 incidence, 494 serologic testing, 495–496 stroke, 494–495 syphilitic gummas, 495 syphilitic meningitis, 494 treatment, 497 pathogenesis, 494 Systemic inflammatory response syndrome (SIRS), 47, 395 Systolic blood pressure (SBP), 547 T Targeted temperature management (TTM), 743 bladder temperature, 763 blood gas interpretation and hypothermia, 765 cold intravenous fluids, 763 complications of, 764–765 endovascular cooling devices, 763–764 hypothermia treatment, duration of, 763 initiate hypothermia, timing of, 762–763 post-cardiac arrest care, 762 surface cooling devices, 764 therapeutic window, 762 TBI See Traumatic brain injury (TBI) TCD See Transcranial Doppler (TCD) Theophylline, 374 Therapeutic hypothermia (TH) acute liver failure, 750 aneurysmal subarachnoid hemorrhage, 749 cardiac arrest, 744 cerebral ischemia, 744 ICH peri-hematomal edema, 748 risk factor, 749 ischemia and stroke hemicraniectomy, 748 pharmacological and physical strategies, 748 post-ischemic edema, 747 rewarming vs normothermia treatment, 747 methods and devices, 746 neuroprotective effect, 745 primary neuronal injury, 744 rewarming, 751–752 risks and side effects, 750–751 secondary neuronal injury, 744 seizures, 749–750 spinal cord injury, 750 TBI, 746 TTM, 743 Index Thermal diffusion flowmetry, 139 Thrombocytopenia incidence, 329 management bleeding risk and platelet transfusions, 332 GPIIb/GPIIIa inhibitor-induced, 330 heparin-induced thrombocytopenia (HIT), 331 passive alloimmune, 330 posttransfusion pupura, 330 pseudothrombocytopenia, 330 thrombotic thrombocytopenic purpura (TTP), 330–331 mechanisms and causes, 329 moderate, 330 platelet counts, 329–330 severe, 330 Thrombolysis blood pressure management, 700–701 intra-arterial thrombolysis, 701–702 intravenous thrombolysis, 698–700 mechanical thrombectomy IV t-PA, 702–703 MERCI devices, 702 oral anticoagulation, 701 transcranial ultrasound, 702 Thrombosis alteplase, 956 aspirin/dipyridamole, 957 heparin, 956 LMWHs and fondaparinux, 957 Thrombotic microangiopathy (TMA), 326–327 Thrombotic thrombocytopenic purpura (TTP), 330–331 Thromboytoses, 333–334 Thyroid releasing hormone (TRH), 295 Thyroid stimulating hormone (TSH), 295 Tinel’s sign, 87 Tinzaparin, 347 Tissue factor (TF), 344 Tonsillar herniation, 832–833 Total parenteral nutrition (TPN), 401 Toxocariasis, 493–494 Transcranial Doppler (TCD), 533, 537, 683, 697, 767 cerebral vasospasm, 551–552 clinical application brain death, 118–119, 121 traumatic brain injury, 118 vasospasm, 118, 120 determination of, 117 pediatrics, 606 shape of waveform, 118, 119 ultrasound waves, 117–118 Transfusion-related acute lung injury (TRALI), 323 Transient left ventricular apical ballooning (TLVAB), 260 Transphenoidal hypophysectomy, 850–851 Transtentorial herniation, 831–832 Transtentorial herniation syndrome, 526 Traumatic brain injury (TBI), 746 amyloid precursor protein, 95 cerebral lesion, 267 chronic traumatic encephalopathy, 95 closed head injury, 94 coagulopathy, 337 contusion/laceration injury, 95 coup contusions, 95 diagnosis, 592–593 diencephalic seizure, 267 diffuse axonal injury (DAI), 95 dysautonomia, 267 Index ECG abnormality, 267 epidemiology CDC definition, 591 deaths, 591 emergency department visits, 591 hospitalizations, 591–592 motor vehicle occupants, 592 pedestrians and cyclists, 592 epidural hemorrhage, 95 excitatory to inbitory ratio model, 268 ICP, 267 monitoring and therapy, CPP lund concept, 250 norepinephrine, 250 pathophysiology, 592 pediatrics adrenal insufficiency, 614 barbiturate coma, 613 biomarkers role, 608 brain oxygen tension, 611 cardiac arrhythmias, 613 cerebrospinal fluid drainage, 612 coagulopathy, 614 CPP, 611 CT (see computed tomography (CT)) decompressive craniectomy, 612–613 epidemiology, 602–603 evaluation, 603 glycemic control, 613–614 grading scales, 603–604 hyperosmolar therapy, 612 induced hypothermia, 612 intracranial hypertension, 610–611 management algorithm, 608–609 MRI, 606 neuromonitoring, 608–610 nutrition, 614 outcome, 614–315 pathogenesis, 603 pilot study, 614 seizure prophylaxis, 613 transcranial Doppler ultrasonography, 606 venous thromboembolism prophylaxis, 614 physiological parameters blood pressure, 594 brain oxygen (PbtO2), 593, 594, 597 CPP/autoregulation, 593, 594 intracranial pressure, 595 (see also Intracranial pressure) microdyalisis, 597–598 seizure prophylaxis, 598 systemic oxygenation, 594 temperature management, 594 prehospital care system, 157 primary damage, 94 secondary damage, 94 spinal cord injury (SCI), 251 STAT, 250 subdural hemorrhage, 95 transcranial Doppler, 118 traumatic intracranial hemorrhage, 95 traumatic spinal cord injury, 96 vascular/meningeal tearing, 96 Traumatic Coma Databank (TCDB), 733 Tuberculoma, 471–472 Tuberculous meningitis clinical presentation, 468–469 diagnosis, 469–470 987 vs HIV infection, 467–468 pathogenesis, 468 prognosis and sequelae, 471 treatment, 470–471 U Uncal herniation, 832 Unfractionated heparin (UFH), 345 United council of neurological subspecialties (UCNS), 4, 24 University health system consortium (UHC), 12 Upper extremity thrombosis, 351 Uremic encephalopathy, 30, 421 V VA See Vertebral artery (VA) VAE See Venous air embolism (VAE) Vagal syncope, 276 Vascular malformation arteriovenous malformations (AVMs), 98–99 capillary telangiectases, 99 cavernous angiomas, 99 venous angiomas, 99 Vascular neurosurgery arteriovenous malformations, 852, 854 carotid endarterectomy, 854 cerebral aneurysms, 851–852 endovascular, 854–855 Vasospasm prophylaxis calcium channel blockers, 553 endovascular interventions, 554–555 ERA, 553–554 magnesium sulfate, 553 medical treatment, 554 statins, 553 triple-H therapy, 552–553 Venous air embolism (VAE), 849 Venous thromboembolism (VTE), 343 clinical consequences, 343 deep vein thrombosis compression ultrasonography (CUS), 349 treatment, 349–351 diagnosis, 349 mechanical prophylaxis graduated compression stockings, 345–346 inferior vena cava filters, 346 intermittent pneumatic compression device, 346 pathogenesis, 344–345 pharmacologic prophylaxis bleeding risks, 347 combination vs mechanical prophylaxis, 346 dalteparin, 347 heparin administration timing, 347 LMWH vs UFH, 347 low-dose UFH and LMWH, 347 tinzaparin, 347 pulmonary embolism, 349–350 risk assessment, 345 treatment alteplase, 350 catheter-based interventions, 350 IVC filters, 350 surgical embolectomy, 350 therapeutic anticoagulation, 350 Ventilation-perfusion (V/Q) scintigraphy, 349 Ventilator-associated pneumonia (VAP), 47–48 988 Ventilator-induced diaphragmatic dysfunction (VIDD), 48–49 Ventilator-induced lung injury (VILI) atelectrauma, 43–44 barotrauma, 44–45 lung protective strategies, 45–46 POT, 44 volutrauma, 43 Ventriculostomy, 130 Vermian lesions, 72 Vertebral artery (VA), 55, 57, 58, 60, 694 Vertebral osteomyelitis clinical presentation and diagnostic considerations, 464–466 incidence, 463 microbiology of, 464 pathogenesis, 464 risk factors, 463–464 treatment, 466 Vestibular schwannoma, 722 Video laryngoscopy Airtraq®, 184, 185 blades shapes, 184 Clarus® Levitan optical airway scope, 184, 186 vs conventional laryngoscopy, 185 device cost, 184 ETT exchange, 186 GlideScope®, 184, 185 glottic view, 186, 187 Storz C-MAC®, 184, 185 Viral meningitis and encephalitis clinical manifestations, 450–451 aseptic meningitis, 451 CSF pleocytosis, 451 LCMV meningitis, 451 epidemiology arboviruses, 447 Coxsackie virus, 447 enteroviruses, 447 rabies, 448 West Nile virus (WNV), 448 laboratory diagnosis, 452–453 nonviral causes of, 454 pathogenesis CSF antibody testing, 448 enterovirus serotype, 451 herpes encephalitis, 449–450, 454–455 macacine herpesvirus 1, 456 PCR testing, 451 Index primary HIV infection, 448 rabies, 455–456 rabies infection, 450 West Nile viral thalamic encephalitis, 455 treatment, 456 Visual agnosias, 78 Visual evoked potentials (VEPs), 115 Visual loss, 848–849 Volutrauma, 43 von Willebrand factor (vWF), 344 W Waddling gait, 72 Wallenberg’s syndrome, 78 Wall motion abnormalities (WMA), 556 Water and electrolyte management calcium disorders, 373 hypercalcemia, 374 hypocalcemia, 374 hypernatremia (see Hypernatremia) hyponatremia (see Hyponatremia) magnesium disorders, 374 hypermagnesemia, 375 hypomagnesemia, 375–376 phosphorus disorders, 373–374 hyperphosphatemia, 374–375 hypophosphatemia, 375 plasma osmolality regulation, 357–358 potassium homeostasis (see Potassium homeostasis) sodium homeostasis, 358–359 sodium plasma concentration, 356–357 Weber’s syndrome, 78 Wernicke’s aphasia, 66 Wernicke’s encephalopathy, 421 Whipple’s disease, 502–503 World Federation of Neurological Surgeons (WFNS), 546, 851 X Xanthochromia, 438 Z Zygomycosis, 480–481 .. .Textbook of Neurointensive Care A Joseph Layon • Andrea Gabrielli William A Friedman Editors Textbook of Neurointensive Care Second Edition Editors A Joseph Layon, MD, FACP Critical Care. .. of hearts, that in 2013 we would see the beginnings—just that of the reform of our health -care system In this context, we have attempted to change and improve our Textbook of Neurointensive Care. .. During the years since the publication of the first edition of this Textbook of Neurointensive Care, considerable developments have evolved in the critical care of the neurologically injured patient