摘要:

Neurologic complications occur in over half of all critically ill patients and may affect outcome as well as length of stay. The most common complications are encephalopathy, seizures, stroke, peripheral neuropathy, and hypoxic-ischemic damage. The principal critical illness that is associated with most of these complications is sepsis, but the specific pathobiology within the nervous system is not well known. Transplantation accounts for the main other critical illness, and complications of hepatic failure and transplantation are discussed. Use of magnetic resonance imaging in comatose patients undergoing transplantation may be revealing, whereas computed tomographic images are not. Diagnosis and monitoring of the nervous system in the intensive care unit in order to detect and manage these complications remains the challenge for the future.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Infectious agents that affect the nervous system can cause their pathology by direct means, such as in meningitis or encephalitis, or indirectly (parainfectious), either from immunologic reactions (Guillain-Barre syndrome, acute disseminated encephalomyelitis) or toxin-mediated reactions (tetanus, botulism). The epidemiology of bacterial meningitis has changed significantly over the past 10 years with the near eradication ofHaemophilus influenzaein the Western world and the emergence of penicillin-resistantStreptococcus pneumoniae.Herpes simplex remains the most common sporadic encephalitis in the United States, with the arboviruses being the most common overall. Human herpes virus 6 is an emerging cause of encephalitis in the immunocompetent and immunodeficient. Rabies remains a rare cause of encephalitis in the United States, is still common worldwide, and has no effective treatment Subacute sclerosing panencephalitis is also rare since the introduction of the measles vaccine but is almost always fatal. A promising treatment regimen for subacute sclerosing panencephalitis is discussed in this review. Two recent studies on the treatment of Guillain-Barre syndrome demonstrate that plasmapheresis and intravenous immunoglobulin are equally effective and that no more than four plasma exchanges are necessary. Acute disseminated encephalomyelitis remains rare and is most common in young adults. Tetanus is still prevalent in developing countries where facilities for critical care are scarce, and for this reason the mortality rate remains very high. Botulism toxin is one of the most potent toxins known and is used both therapeutically and as an agent in biological warfare.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This review focuses on four areas of advances in epilepsy research: status epilepticus, temporal lobe epilepsy, imaging techniques, and new antiepileptic drugs. Results of the first randomized, double-blind clinical trial to compare the drug treatment options for generalized convulsive status epilepticus were announced. There was direct evidence of GABAAreceptor modification during status epilepticus, a role for neuropeptide Y in terminating seizures was described, and finally a genetic basis for susceptibility to neuronal loss during status epilepticus was described. The molecular basis of cell loss and circuit rearrangements in temporal lobe epilepsy was the subject of many studies. Although the consequences of circuit rearrangement remain controversial, there was increasing evidence of unique receptors and ion channels in the epileptic brain. Advanced imaging techniques allowed localization of seizure foci in patients in whom conventional techniques were uninformative. Monotherapy with antiepileptic drugs, gabapentin, lamotrigine, and topiramate, was demonstrated to be safe and efficacious in treatment of partial seizures.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Over the past 2 years, acute ischemic stroke has become a treatable disease. In this short period many consider that the intravenous use of tissue plasminogen activator is the standard of care for acute ischemic stroke for eligible patients; others consider it controversial. Further data has appeared suggesting that streptokinase is potentially dangerous for the same indication. Results of two neuroprotective agents have been published: tirilazad appears to be ineffective, whereas citicoline appears promising. Two large international trials have assessed the impact of aspirin and heparin on stroke showing only a minor benefit of aspirin in the acute management of stroke. Marked advances have occurred in imaging of ischemic acute stroke, mainly in the area of diffusion-weighted imaging, providing a significant research tool and arguably a useful clinical tool for the management and diagnosis of ischemic stroke. More data has appeared regarding the impact of cardiopulmonary bypass on the human nervous system and the impact of carotid stenosis on stroke during this procedure. Finally, more studies on prognosis in neurocritical care patients have appeared including the need for mechanical ventilation, size of stroke, and extent of supratentorial shift in patients with large strokes.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Intensive care plays an important role in the management of subarachnoid and intracerebral hemorrhage. Aggressive intensive care unit-based management protocols for stuporous or comatose patients with subarachnoid hemorrhage, including early aneurysm obliteration and hemodynamic augmentation to treat ischemia from vasospasm, have been shown to increase survival dramatically. Endovascular occlusion of acutely ruptured aneurysms has been shown to prevent early rebleeding and is a promising option for patients who cannot undergo early surgical clipping due to the complexity of their aneurysm or medical comorbidity. Early neurologic deterioration in patients with hypertensive intracerebral hemorrhage has been shown to result from progressive hematoma expansion, which occurs in 30% of patients presenting within 3 hours of onset. Studies of the effects of standard critical care interventions such as blood pressure reduction on early intracerebral hemorrhage growth are needed.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Splanchnic ischemia may be involved in the development of multiple organ failure. Vasoactive agents may influence not only splanchnic blood flow but also the distribution of blood flow within the gut and the balance between oxygen supply and demand in the splanchnic area. This article focuses on the effects of pharmacologic agents including adrenergic agents, prostacyclin, nitric oxide donors or inhibitors, and hemoglobin solutions on splanchnic blood flow.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The adequacy of perfusion of the gut and liver is likely of major importance in critically ill patients because inadequate perfusion could be associated with hepatic and gut injury and dysfunction and consequently patient morbidity and mortality. This article summarizes the various invasive and noninvasive techniques for directly and indirectly assessing the adequacy of splanchnic blood flow and its response to therapeutic interventions. These techniques may yield prognostically important variables and contribute to therapeutic decisions made in various conditions, thereby supplementing global monitoring techniques applied in critically ill patients. Nevertheless, many of these assessments are not applicable on a routine basis because of either their invasive nature or interpretational difficulties. Future studies may be necessary to further define the role of monitoring the adequacy of splanchnic perfusion in the critically ill.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The abdominal compartment syndrome refers to the constellation of altered regional blood flow, abnormal respiratory mechanics, cardiovascular dysfunction, and oliguria that occurs as a result of a sustained increase in intra-abdominal pressure. Although the syndrome may follow a diverse series of insults, the most common predisposing clinical entities are severe abdominal trauma and ruptured abdominal aortic aneurysm. Diagnosis depends on recognition of the clinical syndrome followed by some objective measure of intra-abdominal pressure. When the condition is severe, management requires abdominal decompression. Despite urgent decompression, mortality is high owing to the severity of the patients' underlying illnesses.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Recent research into the cellular and biological mechanisms involved in the inflammatory response in acute pancreatitis has focused on cytokine interactions and their role in the systemic inflammatory response syndrome (SIRS) and the development of clinical complications in this disease. Platelet-activating factor (PAF) has been identified as a dominant cytokine in the SIRS of acute pancreatitis, and PAF antagonism has therefore been a target for therapeutic intervention. If a second phase III trial with lexipafant, a PAF antagonist is successful, then the first specific medical treatment for acute pancreatitis will become available. However, it is likely that lexipafant will ameliorate but not completely reverse the SIRS in acute pancreatitis, and alternative strategies require further study. This review discusses alternative approaches that have been recently investigated. These include modulation of the cellular immune response, manipulation of intracellular signalling mechanisms within the pancreatic acinar cell that initiate the cascade of damage resulting in acinar cell necrosis, and more conservative therapies such as enteral nutrition.

ISSN:1070-5295    

出版商:OVID    

年代:1998

数据来源: OVID