Emergency Management in Neurocritical Care

248 Pages·2012·2.867 MB·English

by  Robert A. Gross, Jonathan W. Mink(eds.)

NEUROLOGY IN PRACTICE:
SERIESEDITORS:ROBERTA.GROSS,DEPARTMENTOFNEUROLOGY,UNIVERSITYOFROCHESTERMEDICALCENTER,ROCHESTER,NY,USA
JONATHANW.MINK,DEPARTMENTOFNEUROLOGY,UNIVERSITYOFROCHESTERMEDICALCENTER,ROCHESTER,NY,USA
Emergency Management in
Neurocritical Care
EDITED BY
E M. M
DWARD ANNO
, , ,
MD FCCM FAAN FAHA
Head,NeurologicalIntensiveCareUnit
ClevelandClinic
Cleveland,OH,USA
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LibraryofCongressCataloging-in-PublicationData
Emergencymanagementinneurocriticalcare/editedbyEdwardM.Manno.
p.;cm.
Includesbibliographicalreferencesandindex.
ISBN978-0-470-65473-6(pbk.:alk.paper)
I.Manno,EdwardM.
[DNLM:1. CentralNervousSystemDiseases–therapy.2. Emergencies.3. Critical
Care–methods.4. IntensiveCareUnits. WL301]
616.800425–dc23
2012002556
AcataloguerecordforthisbookisavailablefromtheBritishLibrary.
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Setin8.75/11.75ptUtopiabyThomsonDigital,Noida,India
1 2012
Contents
List of Contributors vi
Series Foreword viii
Preface ix
PART I: ACUTE MANAGEMENT OF NEUROLOGICAL EMERGENCIES
1 Hypertensive Emergency 3
LaurieMcWilliams
2 Airway Management in the Neurological and Neurosurgical Patient 12
MichaelJ.Souter
3 Traumatic Brain Injury and Intracranial Hypertension 21
IainJ.McCullaghandPeterJ.D.Andrews
4 Critical Care Management of Acute Spinal Cord Injury 32
EdwardM.Manno
5 Subarachnoid Hemorrhage 37
MuhammadA.TaqiandMichelT.Torbey
6 Acute Management of Cerebral Ischemia 45
LeonidGroysmanandGeneSung
7 Neurocritical Care of Intracerebral Hemorrhage 55
JamesM.GebelJr
8 Acute Management of Status Epilepticus 63
JanClaassen
PART II: CEREBROVASCULAR CRITICAL CARE
9 Post-procedural Management of Patients with Aneurysmal Subarachnoid
Hemorrhage 73
TomokoRieSampsonandMichaelN.Diringer
10 Care of the Neurointerventional Patient in the Neurointensive Care Unit 84
RishiGupta
iii
iv.Contents
11 New Treatment Strategies in the Management of Large Hemispheric
Strokes and Intracerebral Hemorrhages 92
EdwardM.Manno
12 Presentation and Management of Acute Cerebral Venous Thrombosis 99
Patrı´ciaCanha˜oandJose´M.Ferro
PART III: INFECTIONS OF THE NERVOUS SYSTEM
13 Infections in the Neurocritical Care Unit 111
DeniseH.Rhoney,KarenJ.McAllen,andDennisParker
14 Diagnosis and Management of Bacterial and Viral Meningitis 123
MaxwellS.Damian
15 Encephalitis: Presentation and Management 132
AliE.ElsayedandBarnettR.Nathan
PART IV: NEUROMUSCULAR COMPLICATIONS ENCOUNTERED IN THE INTENSIVE CARE UNIT
16 Practical Management of Guillain–Barre´ Syndrome and Myasthenic Crisis 143
AlejandroA.Rabinstein
PART V: NEUROLOGICAL COMPLICATIONS AND CONSULTATIONS IN GENERAL INTENSIVE CARE UNITS
17 Metabolic Encephalopathies 155
EdwardM.Manno
18 Delirium and Sedation in the ICU 162
JenniferA.Frontera
19 Neurologic Complications of Cardiac Surgery 174
CathySila
20 Neurological Complications of Medical Illness: Critical Illness
Neuropathy and Myopathy 182
EdwardM.Manno
21 Hypothermia: Application and Use in Neurocritical Care 188
EdwardM.Manno
22 Etiologies of Posterior Reversible Encephalopathy Syndrome and Forms
of Osmotic Demyelination Syndrome 197
J.JavierProvencio
Contents .v
PART VI: ACUTE NEUROIMAGING AND NEUROMONITORING IN NEUROCRITICAL CARE
23 Application of MR Diffusion, CT Angiography and Perfusion Imaging
in Stroke Neurocritical Care 207
CarlosLeiva-Salinas,WadeSmithandMaxWintermark
24 Advanced Monitoring of Brain Oxygenation and Metabolism 214
BharathR.NaravetlaandJ.ClaudeHemphillIII
Index 225
The color plate can be found facing page 54.
Contributors
PeterJ.D.Andrews,MD,MB,ChB,FRCA JenniferA.Frontera,MD
CentreforClinicalBrainSciences NeuroscienceIntensiveCareUnit
UniversityofEdinburgh DepartmentsofNeurosurgeryandNeurology
Edinburgh,UK MountSinaiSchoolofMedicine
NewYork,NY,USA
Patr´ıciaCanha~o,MD,PhD
DepartmentofNeurosciences JamesM.Gebel,Jr,MD,MS,FAHA
Servic¸odeNeurologia CerebrovascularCenter
HospitaldeSantaMaria ClevelandClinic
UniversityofLisbon Cleveland,OH,USA
Lisboa,Portugal
LeonidGroysman,MD
NeurocriticalCareandStrokeDivision
JanClaassenMD,PhD
UniversityofSouthernCalifornia
DivisionofNeurocriticalCareand
LosAngeles,CA,USA
theComprehensiveEpilepsyCenter
DepartmentofNeurology
RishiGupta,MD
ColumbiaUniversity
DepartmentofNeurology,Neurosurgery
NewYork,NY,USA
andRadiology
EmoryUniversitySchoolofMedicine
MaxwellS.Damian,MD,PhD
MarcusStrokeandNeuroscienceCenter
DepartmentofNeurologyand
GradyMemorialHospital
theNeurocriticalCareUnit
Atlanta,GA,USA
CambridgeUniversityHospitals
Cambridge,UK
J.ClaudeHemphillIII,MD,MAS
DepartmentofNeurology
MichaelN.Diringer,MD
UniversityofCalifornia
Neurology/NeurosurgeryIntensive
SanFrancisco,CA,USA
CareUnit
DepartmentofNeurologyand
CarlosLeiva-Salinas,MD
NeurologicalSurgery
DepartmentofRadiology
WashingtonUniversitySchool
NeuroradiologyDivision
ofMedicine
UniversityofVirginia
SaintLouis,MO,USA
Charlottesville,VA,USA
AliE.Elsayed,MD KarenJ.McAllen,Pharm.D
MountainsideHospital DepartmentofPharmacyServices
Montclaire,NJ,USA SpectrumHealthHospitals
GrandRapids,MI,USA
Jose(cid:2) M.Ferro,MD,PhD
DepartmentofNeurosciences IainJ.McCullagh,MBChB,FRCA
Servic¸odeNeurologia DepartmentofAnaesthesia,CriticalCare
HospitaldeSantaMaria andPainManagement
UniversityofLisbon UniversityofEdinburgh
Lisboa,Portugal Edinburgh,UK
vi
Contributors.vii
EdwardM.Manno,MD,FCCM, TomokoRieSampson,MD,MPH
FAAN,FAHA Neurology/NeurosurgeryIntensiveCareUnit
NeurologicalIntensiveCareUnit DepartmentofNeurologyandNeurological
ClevelandClinic Surgery
Cleveland,OH,USA WashingtonUniversitySchoolofMedicine
SaintLouis,MO,USA
LaurieMcWilliams,MD
NeurocriticalCareUnit CathySila,MD
CerebrovascularCenter DepartmentofNeurology
DepartmentofNeurologyandNeurosurgery CaseWesternReserveUniversity
Clevelandclinic SchoolofMedicine
Cleveland,OH,USA andStroke&CerebrovascularCenter,
NeurologicalInstitute
BharathR.Naravetla,MD UniversityHospitals–CaseMedicalCenter
DepartmentofNeurology Cleveland,OH,USA
NeurovascularService
UniversityofCalifornia,SanFrancisco WadeSmith,MD,PhD
SanFrancisco,CA,USA DepartmentofNeurology
UniversityofCalifornia
BartnettR.Nathan,MD SanFrancisco,CA,USA
DepartmentsofNeurologyandInternal
Medicine MichaelJ.Souter,MB,ChB,FRCA
NeuroCriticalCareandNeuroInfectious DepartmentofAnesthesiology&PainMedicine;
Disease andDepartmentofNeurologicalSurgery
UniversityofVirginia UniversityofWashington;
Charlottesville,VA,USA DepartmentofAnesthesiology
HarborviewMedicalCenter
DennisParker,Jr,Pharm.D Seattle,WA,USA
EugeneApplebaumCollegeof
Pharmacy&HealthSciences GeneSung,MD,MPH
WayneStateUniversity NeurocriticalCareandStrokeDivision
Detroit,MI,USA UniversityofSouthernCalifornia
LosAngeles,CA,USA
J.JavierProvencio,MD
CerebrovascularCenter MuhammadA.Taqui,MD
ClevelandClinic DepartmentofNeurologyandNeurosurgery
Cleveland,OH,USA TheOhioStateUniversity
Columbus,OH,USA
AlejandroA.Rabinstein,MD
DepartmentofNeurology MichelT.Torbey,MD,MPH,FAHA,FCCM
MayoClinicCollegeofMedicine DepartmentofNeurologyandNeurosurgery
Rochester,MN,USA TheOhioStateUniversity
Columbus,OH,USA
DeniseH.Rhoney,Pharm.D,
FCCP,FCCM MaxWintermarkMD
EugeneApplebaumCollegeofPharmacy& DepartmentofRadiology
HealthSciences NeuroradiologyDivision
WayneStateUniversity UniversityofVirginia
Detroit,MI,USA Charlottesville,VA,USA
Series Foreword
Thegenesisforthisbookseriesstartedwiththe “Bibliography” sections that guide the reader
proposition that, increasingly, physicians want to additional material.
direct,usefulinformationtohelptheminclinical We welcome feedback. As additional volumes
care.Textbooks,whilecomprehensive,areuseful are added to the series, we hope to refine the
primarily as detailed reference works but pose content and format so that our readers will be
challengesforusesatthepointofcare.Bycon- bestserved.
trast, more outline-type references often leave Ourthanks,appreciation,andrespectgooutto
out the “hows and whys” – pathophysiology, oureditorsandtheircontributors,whoconceived
pharmacology – that form the basis of manage- andrefinedthecontentforeachvolume,assuring
ment decisions. Our goal for this series is to ahigh-quality,practicalapproachtoneurological
presentbooks,coveringmostareasofneurology, conditionsandtheirtreatment.
thatprovideenoughbackgroundinformationto Ourthanksalsogotoourmentorsandstudents
allow the reader to feel comfortable, but not so (past,present,andfuture),whohavechallenged
much as to be overwhelming; and to associate and delighted us; to our book editors and their
that with practical advice from experts about contributors, who were willing to take on addi-
care,combiningthegrowingevidencebasewith tional work for an educational goal; and to our
bestpractices. publisher,MartinSugden,forhisideasandsup-
Our series will encompass various aspects of port for wonderful discussions and commisera-
neurology, with topics and the specific content tion over baseball and soccer teams that might
chosentobeaccessibleanduseful. notquitehaveliveduptoexpectations.Wewould
Chapterscovercriticalinformationthatwill like to dedicate the series to Marsha, Jake and
informthereaderofthediseaseprocessesand Dan;andtoJanet,LauraandDavid.Andalsoto
mechanisms as a prelude to treatment plan- StevenR.Schwid,MD,ourfriendandcolleague,
ning.Algorithmsandguidelinesarepresented, whose ideas helped to shape this project and
when appropriate. “Tips & Tricks” boxes pro- whosehumorbrightenedourlives,buthecould
vide expert suggestions, while other boxes notcompletethisgoalwithus.
present cautions and warnings to avoid pit-
falls. Finally, we provide “Science Revisited” RobertA.Gross
sections that review the most important and JonathanW.Mink
relevant science background material, and Rochester,July2011
viii
Preface
Sinceitsbeginningintheearly1980sthefieldof ders,epilepsy,andneurologicalconsultationsin
neurocriticalcarehasexpandedatadramaticrate. general intensive care unit are included. A final
Inthelastdecadetherehasbeenthedevelopment section on neuroimaging and neuromonitoring
ofaninternationalsocietywithover1000mem- reflects the growing reliance on technology in
bers,aspecializedjournalwithagrowingimpact neurologicalcriticalcare.
factor, accredited fellowship programs, and a The chapters are written by experts in their
board certification process through the United respective areas and represent a worldwide dis-
Council of Neurological Subspecialties. To date tributionofmultidisciplinary authors.Thebook
therearecloseto100neurocriticalcareunitsinthe containsmoredetailedinformationthanahand-
UnitedStates,asimilarnumberinEurope,anda book, but is presented in a concise and user-
growingpresenceinSouthAmericaandAsia.The friendly manner to serve as a quick reference
inclusionofatextbookofNeurocriticalCareinthe whenneeded.The“Tips&Tricks”and“Science
NeurologyinPracticeseriesisatestimonytothe Revisited” sections are designed to increase the
field’sgrowinginfluence. readabilityofthechapters.
Therapidgrowthofneurocriticalcarehasen- Endeavorsofthissizearenotundertakenwith-
couragedacommensurategrowthofliteraturein out help, and I would like to thank Jonathan
thefield.Interestingly,thishasmostlytakenthe MinkMD,oneoftheserieseditor,forincluding
formofsingleauthortextsorhandbooksprimarily this topic. I would also like to thank Lewis
designedtodisseminateinformationquicklyand O’Sullivan, Martin Sugden, Michael Bevan, and
systematicallytokeeppacewiththisgrowingfield. Lucinda Yeates at Wiley–Blackwell Publishing
This book, Emergency Management in Neuro- who were instrumental in guiding me through
criticalCareisthefirstmulti-authored textbook this process.
inthefieldsincethefirsttext,Neurologicaland Finally,myfatherpassedawayduringtheedit-
NeurosurgicalIntensiveCare,waseditedbyAllan ing of this text, and on retrieving his personal
RopperandSeanKennedyin1983.Theprimary itemsIdiscoveredanumberofmedalsofvalorhe
aim is to provide a comprehensive guide to the receivedduringWorldWarII.Heneverspokeof
management of acutely ill neurological or neu- theseandmyfamilywasunawareofhisposses-
rosurgicalpatientswherevertheymaybelocated sions.Thisbookisdedicatedtohimandtoallthe
inthehospital.Thescopeofthebookwillinclude physicians, nurses, and personnel inthe neuro-
basic principles in emergency neurology and logical intensive care unit and elsewhere who
critical care, which will review the underlying perform daily acts of valor with no expectation
basicscienceandcerebrovascularphysiologyof ofrecognition.
the critically ill neurological patient. Later sec-
tionswillfocusmoreonthecriticalaspectsofthe EdwardM.Manno
neurologically ill. Specific sections dedicated to Cleveland
cerebrovascular disease, neuromuscular disor-
ix
Plate 7.1 Congo red staining of cerebral amyloid angiopathy showing thickened sub-
corticalarteriolewall(left)whichdemonstratesapplegreenbirefringence(right)whichis
neuropathologically diagnostic of the condition.
Plate 23.1 Mismatch between PCT MTT and CBV defects in a 63-year-old man
evaluated3hoursaftersuddenonsetofrightface-arm-legweakness.CTAimagesshow
occlusion of the distal M1 segment of the left middle cerebral artery. CTA curved
multiplanar reconstruction shows a calcified plaque at the origin of the left internal
carotidartery(arrowhead)withabypassfromtheleftcommoncarotidarterytothedistal
left internal carotid artery. PCT parametric maps show a mismatch between the region
withprolongedMTT(whitearrows)andtheabsenceofdecreasedCBV(CBVisincreased)
(gray arrow). PCT source images (PCT SI) show good collateral flow in the tissue with
prolonged MTT and no area showing paucity of vessels. The patient was treated with
intravenous tPA. Follow upDWIimage performed12hourslater(Follow-up) show two
smallinfarctsinthewatershedterritories,representedbythesmallfociofrestrictedwater
diffusion (purple arrows).