Neurocritical care
-
The core challenge of pain management in neurocritical care is to keep the patient comfortable without masking or overlooking any neurological deterioration. Clearly in patients with a neurological problem there is a conflict of clinical judgement and adequate pain relief. Here we review the presentation, assessment, and development of pain in the clinical spectrum of patients with associated neurological problems seen in a general intensive care setting. ⋯ There is evidence that swift and targeted pain management may improve the outcome. Importantly pain management is multidisciplinary. The available non-invasive, pharmacological, and invasive treatment strategies are discussed.
-
Cerebral edema develops in response to and as a result of a variety of neurologic insults such as ischemic stroke, traumatic brain injury, and tumor. It deforms brain tissue, resulting in localized mass effect and increase in intracranial pressure (ICP) that are associated with a high rate of morbidity and mortality. When administered in bolus form, hyperosmolar agents such as mannitol and hypertonic saline have been shown to reduce total brain water content and decrease ICP, and are currently the mainstays of pharmacological treatment. ⋯ Herein, we review the available studies employing sustained hyperosmolar therapy to induce hypernatremia for the prevention and/or treatment of cerebral edema. Insufficient evidence exists to recommend pharmacologic induction of hypernatremia as a treatment for cerebral edema. The strategy of vigilant avoidance of hyponatremia is currently a safer, potentially more efficacious paradigm.
-
Review Case Reports
A Major Pitfall to Avoid: Retroclival Hematoma due to Odontoid Fracture.
Retroclival hematoma (RCH) is a rare occurrence. The hemorrhage is usually small and hidden and can be easily missed on CT scan. Here, we report the association of a RCH with an odontoid fracture. ⋯ In the appropriate clinical setting, when a RCH is found, further imaging should be considered to rule out fracture of the cervical spine. Odontoid fractures can lead to compression of the spinal cord or lower medulla. To prevent neurologic injury and subsequent complications, prompt recognition of type II odontoid fracture should lead to immediate spine stabilization.
-
Review Case Reports
Perimesencephalic subarachnoid hemorrhage triggered by hypoxic training during swimming.
Perimesencephalic subarachnoid hemorrhage is a rare neurologic condition of unclear etiology. Multiple mechanisms have been postulated as potential triggers, but none are universally accepted. ⋯ The occurrence of perimesencephalic subarachnoid hemorrhage during hypoxic training suggests that acute venous congestion may be a triggering factor. The increasing popularity of hypoxic training demands vigilance from health care providers.
-
Review Case Reports
The white cerebellum sign: an under recognized sign of increased intracranial pressure.
The "white cerebellum" sign is a rare imaging finding described mainly in children with hypoxic brain injury. ⋯ The white cerebellum sign is a subtle imaging finding seen in patients with diffuse cerebral edema, such finding may not be as ominous as previously thought.