Book contents
- Frontmatter
- Contents
- Contributors
- Foreword
- Introduction
- SECTION I PRINCIPLES OF NEUROCRITICAL CARE
- SECTION II NEUROMONITORING
- SECTION III MANAGEMENT OF SPECIFIC DISORDERS IN THE NEUROCRITICAL CARE UNIT
- 10 Ischemic Stroke
- 11 Intracerebral Hemorrhage
- 12 Cerebral Venous Thrombosis
- 13 Subarachnoid Hemorrhage
- 14 Status Epilepticus
- 15 Nerve and Muscle Disorders
- 16 Head Trauma
- 17 Encephalopathy
- 18 Coma and Brain Death
- 19 Neuroterrorism and Drug Overdose
- 20 Central Nervous System Infections
- 21 Spinal Cord Injury
- 22 Postoperative Management in the Neurosurgical Critical Care Unit
- 23 Ethical and Legal Considerations in Neuroscience Critical Care
- SECTION IV MANAGEMENT OF MEDICAL DISORDERS IN THE NEUROCRITICAL CARE UNIT
- Index
- Plate section
17 - Encephalopathy
from SECTION III - MANAGEMENT OF SPECIFIC DISORDERS IN THE NEUROCRITICAL CARE UNIT
Published online by Cambridge University Press: 27 April 2010
- Frontmatter
- Contents
- Contributors
- Foreword
- Introduction
- SECTION I PRINCIPLES OF NEUROCRITICAL CARE
- SECTION II NEUROMONITORING
- SECTION III MANAGEMENT OF SPECIFIC DISORDERS IN THE NEUROCRITICAL CARE UNIT
- 10 Ischemic Stroke
- 11 Intracerebral Hemorrhage
- 12 Cerebral Venous Thrombosis
- 13 Subarachnoid Hemorrhage
- 14 Status Epilepticus
- 15 Nerve and Muscle Disorders
- 16 Head Trauma
- 17 Encephalopathy
- 18 Coma and Brain Death
- 19 Neuroterrorism and Drug Overdose
- 20 Central Nervous System Infections
- 21 Spinal Cord Injury
- 22 Postoperative Management in the Neurosurgical Critical Care Unit
- 23 Ethical and Legal Considerations in Neuroscience Critical Care
- SECTION IV MANAGEMENT OF MEDICAL DISORDERS IN THE NEUROCRITICAL CARE UNIT
- Index
- Plate section
Summary
Encephalopathy is a common complication of systemic illness or direct brain injury. It can manifest as a spectrum that begins with subtle cognitive changes, progresses as a full-blown syndrome of brain dysfunction, and eventually leads to coma or brain death (the latter two are described in separate chapters). In this chapter, we focus on the detection, etiologic diagnosis, and management of noncomatose, critically ill, encephalopathic patients. Their condition has been traditionally known with several interchangeable names such as acute confusional state, acute organic brain syndrome, and acute cerebral insufficiency, but is most commonly referred to as delirium.
Delirium contributes significantly to lengthened hospital stay, increased morbidity and mortality, increased overall medical costs, and worse long-term neurocognitive outcomes. Despite the awareness of its existence since the earliest historical medical documents, timely detection, workup, and appropriate management continue to present challenges for the treating physicians. Delirious patients in the Intensive Care Unit (ICU) form a particularly understudied population with unique characteristics.
▪ Delirium has been described as an acute alteration of consciousness and higher cognitive functions.
▪ It typically develops over a short period of time and has a fluctuating course.
▪ It is a well-defined syndrome that may be precipitated by several diverse pathological processes.
▪ The current edition of the Diagnostic and Statistic Manual (DSM-IV TR) lists criteria for the diagnosis of delirium due to a general medical condition (Table 17.1).
The incidence of delirium has been estimated as between 5% and 40% for hospitalized patients in general and between 11% and 80% for critically ill patients.
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- Neurocritical Care , pp. 220 - 226Publisher: Cambridge University PressPrint publication year: 2009
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