Neurologic clinics
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Treatment of ischemic deficits caused by vasospasm relies on enhancing cardiac output, inducing arterial hypertension, and expanding the intravascular volume in an attempt to improve CBF. Different treatment protocols exist from institution to institution to achieve these goals. The role of calcium-channel blockers now is well established. ⋯ Phenylephrine was started but she developed precordial lead ST elevation and elevated cardiac enzymes. Topical nitrate therapy was initiated and phenylephrine was discontinued. The patient underwent emergent cerebral angiography, which demonstrated moderate to severe bilateral ACA spasm and moderate right MCA spasm.(ABSTRACT TRUNCATED AT 400 WORDS)
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Review Case Reports
Neurophysiologic monitoring in the neuroscience intensive care unit.
Neurologically critically ill patients, more often than others, are unable to communicate and, for a crucial period of time, have the vital functions of their brains hidden in the "black box" of the cranial vault behind a curtain of ambiguity and immobility. Customarily--and naively--we have relied upon beside clinical observations to pierce these barriers. Recent insights lead us to conclude that these "neurochecks" no longer suffice. ⋯ We soon may see a scalp array of such detectors, similar to an EEG "montage," that allows us to assess multiregional Scvo2. To be useful, a clinical method should raise questions for further investigation. If the neurophysiologic monitoring systems described here provide us with some answers and lead us to ask useful new questions, they will prove their benefit to our patients.
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Review Case Reports
Malignant cerebral edema and intracranial hypertension.
Cerebral edema and intracranial hypertension occur frequently in neurologic patients. Proper understanding of the pathophysiology of each entity allows prompt recognition and rational therapeutic goals, allowing for better neurologic outcome in many disease states. The recognition of cerebral edema as a distinct entity allows the clinician to treat focal pressure gradients in the brain separately from more diffuse intracranial pressure elevations, appreciating the benefits and pitfalls of directed therapies for each process. The treatment of many of the disorders that cause cerebral edema and intracranial hypertension is heuristic, challenging the managing physician's thorough understanding of cerebral hemodynamics and his or her ability to encounter the human aspects of determining appropriate levels of care for individual patients.
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Review Case Reports
Ventilatory management in critical neurologic illness.
Evolution and refinement of airway and ventilatory management has taken place in neurologic critical care. Applications for ventilatory management have been extended to virtually all acute life-threatening illnesses found in neurologic critical care units today. This article focuses on the airway and ventilatory management of patients with acute raised intracranial pressure, cervical spine injuries, and neuromuscular ventilatory failure.
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The widespread use of video-electroencephalogram monitoring has dramatically increased our recognition of the high prevalence and diversity of nonepileptic seizures. Nonepileptic seizures stand squarely in the interface between psychiatry and neurology, an area that has been both claimed and denied by both sides. Collaborative exploration of this border zone has provided new insights into a disorder that may be as ancient as epilepsy.