Assessment of Cerebral Dysfunction

  • N. Stocchetti
  • E. Calappi
  • A. Chieregato
Conference paper


The following notes are intended for use in the Critical Care setting. In this situation two distinct scenarios may challenge the knowledge of the attending physician: in the first scenario an acute patient presents a sudden deterioration of his neurological status. In the second scenario a case with established diagnosis of neurological damage should be followed in his clinical course, and neuro monitoring is used in order to assess the trend of his cerebral damage. In the first part of this survey we will cover the acute diagnostic problems of a patient with impaired consciousness. In the second part we will touch some aspects of intracranial pressure monitoring, one of the key parameters in neuro intensive care.


Cerebral Blood Flow Intracranial Pressure Intracranial Hypertension Cerebral Perfusion Pressure Severe Head Injury 
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  1. 1.
    Bates D (1993) The management of medical coma. J Neurol Neurosurgery Psychiatry 56: 589–598CrossRefGoogle Scholar
  2. 2.
    Domino KB (1994) Care of the acutely unstable patient. In: Cottrell JE, Smith DS (ed) Anesthesia and neurosurgery. Mosby St Louis, pp 260–284Google Scholar
  3. 3.
    Ross SE, Schwab CW, David ET et al (1987) Clearing the cervical spine: initial radiologic evaluation. J Trauma 27:1055–1060PubMedCrossRefGoogle Scholar
  4. 4.
    Andersen BJ, Unterberg AW, Clarke GD et al (1988) Effect of posttraumatic hypoventilation on cerebral energy metabolism. J Neurosurg 68:601–607PubMedCrossRefGoogle Scholar
  5. 5.
    Piek J, Chesnut RM, Marshall LF et al (1992) Extracranial complications of severe head injury. J Neurosurg 77:901–907PubMedCrossRefGoogle Scholar
  6. 6.
    Chesnut RM, Marshall LF, Klauber MR et al (1993) The role of secondary brain injury in determining outcome from severe head injury. J Trauma 34:216–222PubMedCrossRefGoogle Scholar
  7. 7.
    Stocchetti N, Furlan A, Volta F (1996) Hypoxemia and arterial hypotension at the accident scene in head injury. J Trauma 40:764–767PubMedCrossRefGoogle Scholar
  8. 8.
    Giannotta SL, Weiss MH (1982) Pitfalls in the diagnosis of head injury. Clin Neur Surg 29: 288–299Google Scholar
  9. 9.
    Jennet B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet 1:480–484CrossRefGoogle Scholar
  10. 10.
    Born JD, Hans P, Abert A et al (1987) Interobserver agreement in assessment of motor response and brain stem reflexes. Neurosurgery 20:513–515PubMedCrossRefGoogle Scholar
  11. 11.
    Plum F, Posner JB (1980) The diagnosis of stupor and coma. F.A. Davis Company, PhiladelphiaGoogle Scholar
  12. 12.
    Romana G, Larson SJ (1984) Influence of stimulus location and limb position on motor responses in the comatose patients. J Neurosurg 61:725–728CrossRefGoogle Scholar
  13. 13.
    Fitzgerald FT, Tierney LM, Wall SD (1983) The comatose patient. A systematic diagnostic approach for you to follow. Postgraduate Med 74:207–215Google Scholar
  14. 14.
    Chesnut RM, Gautille T, Blunt B et al (1994) The localizing value of asymmetry in pupillary size in severe head injury: relation to lesion type and location. Neurosurgery 34:251–256Google Scholar
  15. 15.
    Caronna JJ (1987) Coma assessment and management. In: Parrillo JE (ed) Current therapy in critical care medicine. Decker Inc. Toronto, pp 223–227Google Scholar
  16. 16.
    Langfitt TW, Weinstein JD, Kassel NF et al (1964) Transmission of increased intracranial pressure within the craniospinal axis. J Neurosurg 21:986–997Google Scholar
  17. 17.
    Go KG (1991) Cerebral pathophysiology. Elsevier, Amsterdam, pp 173–207Google Scholar
  18. 18.
    Welch K (1980) The intracranial pressure in infants. J Neurosurg 52:693–699PubMedCrossRefGoogle Scholar
  19. 19.
    Narayan RK, Greenberg RP, Miller JD et al (1981) Improved confidence of outcome prediction in severe head injury. J Neurosurg 54:751–762PubMedCrossRefGoogle Scholar
  20. 20.
    Marmarou A, Anderson RL, Ward JD et al (1991) Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J Neurosurg 75:59–66Google Scholar
  21. 21.
    Hsiang JK, Chesnut RM, Crisp CB et al (1994) Early, routine paralysis for intracranial pressure control in severe head injury: is it necessary? Crit Care Med 22:1471–1476PubMedCrossRefGoogle Scholar
  22. 22.
    Miller JD (1985) Head injury and brain ischemia-implications for therapy. Br J Anaest 57: 120–129CrossRefGoogle Scholar
  23. 23.
    Rosner MJ, Newsome HH, Becker DP (1984) Mechanical brain injury: the sympathoadrenal response. J Neurosurg 61:76–86PubMedCrossRefGoogle Scholar
  24. 24.
    Neaman MM, Kligerman M, Willcox M (1984) Pulmonary hypertension, pulmonary edema, and decreased pulmonary compliance produced by increased ICP in cats. J Neurosurg 60: 1207–1213CrossRefGoogle Scholar
  25. 25.
    Demling R, Riessen R (1990) Pulmonary dysfunction after cerebral injury. Crit Care Med 18: 768–774PubMedCrossRefGoogle Scholar
  26. 26.
    Cooper KR, Boswell PA, Choi SC (1985) Safe use of PEEP in patients with severe head injury. J Neurosurg 63:552–555PubMedCrossRefGoogle Scholar
  27. 27.
    Toutant SM, Todd MM, Drummond JC et al (1983) Cerebral blood flow during high frequency ventilation in cats. Crit Care Med 11:712–715PubMedCrossRefGoogle Scholar
  28. 28.
    Hurst JM, Saul TG, Dehaven CB et al (1984) Use of high frequency jet ventilation during mechanical hyperventilation to reduce intracranial pressure in patients with multiple organ system injury. Neurosurgery 15: 530–534PubMedCrossRefGoogle Scholar
  29. 29.
    Maset AL, Marmarou A, Ward JD et al (1987) Pressure-volume index in head injury. J Neurosurg 67:832–840PubMedCrossRefGoogle Scholar
  30. 30.
    El-Adawy Y, Rosner MJ (1989) Cerebral perfusion pressure, autoregulation and the PVI reflection point: pathological ICP. In: Hoff JT, Betz AL (eds) Intracranial Pressure VII. Springer, Berlin Heidelberg New York, pp 829–833CrossRefGoogle Scholar
  31. 31.
    Ursino M, Iezzi M, Stocchetti N (1995) Intracranial pressure dynamics in patients with acute brain damage: a critical analysis with the aid of a mathematical model. IEEE Transactions on Biomedical Engineering 42:529–540PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 1997

Authors and Affiliations

  • N. Stocchetti
  • E. Calappi
  • A. Chieregato

There are no affiliations available

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