Skip to main content

Coma and Intensive Care Neurology

  • Chapter
Book cover Atlas of Clinical Neurology

Abstract

Neurocritical care is a subspecialty that has grown during the past 15 years. Critical care is care that is rendered in an acute and emergent setting in which the absence of care is associated with severe disability or death. The critical care concept evolved out of the need to render time-dependent emergent therapies in acute respiratory failure during the polio epidemics and for arrhythmia experienced by heart attack victims. Critical care grew rapidly in the 1970s to provide supportive care for the sickest patients with cardiologic, pulmonologic, and gastrointestinal disorders. In the 1980s the analogous subsets of neurologic and neurosurgical patients began to be identified. Neurocritical Care Units are now populated with head trauma victims, subarachnoid hemorrhage patients, the small numbers of patients who have treatable stroke, and patients with infectious disorders, including meningitis, encephalitis, and the parainfectious diseases, such as Guillain-Barré syndrome and myasthenia gravis. This chapter illustrates the time dependence and therapeutic complexities associated with these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 74.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Ramsay MAE, Savege TA, Simpson BRJ, Goodwin R: Controlled sedation with alphaxalone-alphadolone. BMJ 1974, 2: 656–659.

    Article  PubMed  CAS  Google Scholar 

  2. Mirski MA, Muffelman B, Ulatowski JA, et al.: Sedation for the critically ill neurologic patient. Crit Care Med 1995, 23:2038–2053.

    Article  PubMed  CAS  Google Scholar 

  3. Teasdale G, Jennett B: Assessment of coma and impaired consciousness. Lancet 1974, 1: 878–881.

    Google Scholar 

  4. Ropper AH: Neurological and Neurosurgical Intensive Care, edn 3. New York: Raven Press; 1993.

    Google Scholar 

  5. Wijdicks EFM: Neurology of Critical Illness. Philadelphia: FA Davis, 1995.

    Google Scholar 

  6. Hacke W, ed: Neurocritical Care. Berlin: Springer-Verlag, 1994.

    Google Scholar 

  7. Grotta JC: Management of the Acutely Ill Neurological Patient. New York: Churchill Livingstone, 1993.

    Google Scholar 

  8. Classification of cerebrovascular disease III. Special report from the National Institute of Neurological Disorders and Stroke. Stroke 1990, 21: 637–676.

    Google Scholar 

  9. Mohr JP, Barnett HJM: Classification of Ischemic Strokes. In Stroke: Pathophysiology, Diagnosis and Management. Edited by Barnett HJM, Mohr JP, Stein BM, Yatsu FM. New York: Churchill Livingstone; 1986: 281–292.

    Google Scholar 

  10. Kittner SJ, Sharkness CM, Sloan MA, et al.: Infarcts with a cardiac source of embolism in the NINDS Stroke Data Bank. Neurology 1992, 42:299–302.

    Google Scholar 

  11. Mohr JP, Caplan LR, Melski JW, et al.: The Harvard registry of cases hospitalized with stroke. Neurology 1978, 28:754–762.

    Google Scholar 

  12. Kunitz S, Gross CR, Heyman A, et al.: The pilot stroke data bank: definition, design, data. Stroke 1984, 15:740–746.

    Google Scholar 

  13. Fisher MC: Principles of Diagnosis and Management of Occlusive Cerebrovascular Disease. In Neurological and Neurosurgical Intensive Care, edn 3. Edited by Ropper HH. New York: Raven Press; 1993.

    Google Scholar 

  14. Brucher R, Russell D: Methods and Clinical Potential. Neurosonology. Edited by Tegeler CH, Babikian VL, Gomez CR. St. Louis: Mosby-Year Book; 1995: 231–234.

    Google Scholar 

  15. Bryan RN, Levy LM, Whitlow WD, et al.: Diagnosis of acute cerebral infarction: comparison of CT and MR imaging. AJNR 1992, 8:245–263.

    Google Scholar 

  16. Yuh WT, Crain MR, Loes DJ, et al.: MR imaging of cerebral ischemia: findings in the first 24 hours. AJNR 1991, 12:621–629.

    Google Scholar 

  17. Mathews VP, Barker PB, Bryan RN: Magnetic resonance evaluation of stroke. Magnetic Resonance Quarterly 1992, 4: 245–263.

    Google Scholar 

  18. Aaslid R, ed: Transcranial Doppler Sonography. New York Springer-Verlag; 1986.

    Google Scholar 

  19. Hereda P, Traubner P, Bujdakova J: Short-term prognosis of stroke due to occlusion of internal carotid artery based on transcranial Doppler ultrasonography. Stroke 1992, 23: 1069–1072.

    Article  Google Scholar 

  20. Halsey JH Jr: Prognosis of acute hemiplegia estimated by transcranial Doppler ultrasonography. Stroke 1988, 19: 648–649.

    Article  PubMed  Google Scholar 

  21. Von Kummer R, Bozzao L, Manelfe C: Early CT diagnosis of hemispheric brain infarction. Berlin: Springer-Verlag; 1995.

    Book  Google Scholar 

  22. Del Zoppo GJ: Thrombolytic therapy in acute stroke: recent experience. Cerebrovasc Dis 1993, 3: 256–263.

    Article  Google Scholar 

  23. Brott TL: Thrombolytic therapy. Neurol Clin North Am 1992, 10: 219–232.

    CAS  Google Scholar 

  24. Brandt T, Muller-Kuppers M, von Kummer R, et al.: Thrombolytic therapy for acute basilar artery occlusion: predictors for recanalization and outcome. Stroke 1996, 27:875–881.

    Google Scholar 

  25. Hacke W, Zeumer H, Ferbert A, et al.: Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke 1988, 19:1216–1222.

    Google Scholar 

  26. Zeumer H, Freitag H-J, Zanella F, et al.: Local intra-arterial fibrinolytic therapy in patients with stroke: urokinase versus recombinant tissue plasminogen activator (r-TPA). Neuroradiology 1993, 35:159–162.

    Google Scholar 

  27. Bockenheimer St, Reinhuber F, Mohs C: Intraarterielle thrombolyse himversorgender Gefäße. Radiologe 1991, 31: 210–215.

    Google Scholar 

  28. Becker KJ, Monsein LH, Ulatowski JA, et al.: Intraarterial thrombolysis in vertebrobasilar occlusion. AJNR 1996, 17:1–8.

    Google Scholar 

  29. Brass LM: Clinical Syndromes of Intracerebral Hemorrhage. In Intracerebral Hemorrhage. Edited by Feldmann E. Armonk, NY: Futura Publishing; 1994: 223–255.

    Google Scholar 

  30. Kelly MA: Management of Intracerebral Hemorrhage. In Atlas of Cerebrovascular Disease. Edited by Gorelick PB. Philadelphia: Current Medicine; 1996:20. 1–20. 10.

    Google Scholar 

  31. Kistler JP, Gress DR, Crowell RM: Subarachnoid Hemorrhage Due to a Ruptured Saccular Aneurysm. In Clinical Atlas of Cerebrovascular Disorders. Edited by Fisher M. London: Mosby-Wolfe; 1994:12. 1–12. 14.

    Google Scholar 

  32. Origitano TC: Treatment of Aneurysmal Subarachnoid Hemorrhage. In Atlas of Cerebrovascular Disease. Edited by Gorelick PB. Philadelphia: Current Medicine; 1996:19. 1–19. 11.

    Google Scholar 

  33. Dorsch NW, King MT: A review of cerebral vasospasm in aneurysmal Subarachnoid hemorrhage. Part I: Incidence and effects. J Clin Neurosci 1994, 1: 19–26.

    Article  PubMed  CAS  Google Scholar 

  34. Martin N, Khanna R, Rodts G: The Intensive Care Management of Patients with Subarachnoid Hemorrhage. In Neurocriticallntensive Care. Edited by Andrew BT. New York: McGraw-Hill; 1993: 291–310.

    Google Scholar 

  35. Seiler R, Newell DW: Subarachnoid hemorrhage and vasospasm. In Transcranial Doppler. Edited by Newell DW, Aaslid R. New York: Raven Press; 1992: 101–107.

    Google Scholar 

  36. Griffin DE: Encephalitis, Myelitis, and Neuritis. In Principles and Practice of Infectious Diseases, edn 4. Edited by Mandell GL, Bennett JE. New York: Churchill Livingstone; 1995: 874–881.

    Google Scholar 

  37. Hanley DF, Glass JD, McArthur JC, Johnson RT: Viral Encephalitis and Related Conditions. In Atlas of Infectious Diseases, vol 3. Edited by Mandell GL, Bleck TP. Philadelphia: Current Medicine; 1995:3. 1–3. 36.

    Google Scholar 

  38. Mateos-Mora M, Ratzan KR: Acute Viral Encephalitis. In Infectious of the Nervous System. Edited by Schlossberg D. New York: Springer-Verlag; 1990: 105–134.

    Chapter  Google Scholar 

  39. Whitley RJ, et al.: Herpes simplex encephalitis: Clinical assessment. JAMA 1982, 247:317–320.

    Google Scholar 

  40. Whitney RJ, Schlitt M: Encephalitis Caused by Herpesviruses, Including B Viruses. In Infections of the Central Nervous System. Edited by Scheld RJ, Whitley RJ, Durack DT. New York: Raven Press; 1991: 53–55.

    Google Scholar 

  41. Johnson RT: Current Therapy in Neurologic Disease, edn 2. Philadelphia: BC Decker; 1987.

    Google Scholar 

  42. Cascino GD: Nonconvulsive status epilepticus in adults and children. Epilepsia 1993, 34 (suppl 1): S21 - S28.

    Article  PubMed  Google Scholar 

  43. Lowenstein DH, Alldredge BK: Status epilepticus at an urban public hospital in the 1980s. Neurology 1993, 43: (3 Pt 1): 483–488.

    Article  PubMed  CAS  Google Scholar 

  44. Treiman DM: The role of benzodiazepines in the management of status epilepticus. Neurology 1990, 40: 32–42.

    PubMed  CAS  Google Scholar 

  45. Lothman E: The biochemical basis and pathophysiology of status epilepticus. Neurology 1990, 40 (suppl 2): 13–23.

    PubMed  CAS  Google Scholar 

  46. Treiman DM: Status Epilepticus. In Current Therapy in Neurological Diseases, edn 2. Edited by Johnson RT. Philadelphia: BC Decker; 1987: 38–42.

    Google Scholar 

  47. Treiman DM: Generalized convulsive status epilepticus in the adult. Epilepsia 1993, 34: S2 - S11.

    Article  PubMed  Google Scholar 

  48. Yaffe K, Lowenstein DH: Prognostic factors of pentobarbital therapy for refractory generalized status epilepticus. Neurology 1993, 43: 895–900.

    Article  PubMed  CAS  Google Scholar 

  49. Kumar A, Bleck TP: Intravenous midazolam for the treatment of refractory status epilepticus. Crit Care Med 1992, 20: 483–488.

    Article  PubMed  CAS  Google Scholar 

  50. Lowenstein DH, Aminoff MJ, Simon RP: Barbiturate anesthesia in the treatment of status epilepticus: clinical experience with 14 patients. Neurology 1988, 38: 395–400.

    Article  PubMed  CAS  Google Scholar 

  51. Mirski MA, Williams MA, Hanley DF: Prolonged pentobarbital and phenobarbital coma for refractory generalized status epilepticus. Crit Care Med 1995, 23: 400–403.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2003 Springer Science+Business Media New York

About this chapter

Cite this chapter

Hanley, D.F., Bhardwaj, A., Ulatowski, J.A., Razumovsky, A., Mirski, M.A. (2003). Coma and Intensive Care Neurology. In: Rosenberg, R.N. (eds) Atlas of Clinical Neurology. Current Medicine Group, London. https://doi.org/10.1007/978-1-4757-4552-8_4

Download citation

  • DOI: https://doi.org/10.1007/978-1-4757-4552-8_4

  • Publisher Name: Current Medicine Group, London

  • Print ISBN: 978-1-4757-4554-2

  • Online ISBN: 978-1-4757-4552-8

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics