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Therapeutic hypothermia (TH) is defined as the active lowering of core body temperature with the purpose of preserving organ function. Despite ample animal and clinical data demonstrating a neuroprotective effect from induced hypothermia after cardiac arrest, stroke, and traumatic brain injury, the use of TH in clinical practice remains limited due to side effects, lack of consensus on the ideal duration and goal targeted temperature, and major limitations in infrastructure. The term TH is being replaced by a more specific term “targeted temperature management” (TTM) to represent a range of temperature goals defined as mild (34.5–36.5 °C), moderate (34.5–32 °C), marked (28–32 °C), and profound hypothermia (<28 °C). In this chapter, we will review the different mechanisms, technology, and clinical indications for TH.
A significant number of critically ill neurological and neurosurgical patients are still managed in the medical or surgical ICU by non-neurointensivists, who have a hard time appreciating the delicate needs of these patients. This dynamic guide reviews current topics facing neurocritical care providers in a straight-forward, structured, and practical way. Providing clear summaries in the management of neuro critical care conditions, this text allows for accessible, highly structured, and focused protocols for the assessment, day-to-day management, and treatment of critically ill patients in various ICU settings. This comprehensive, thorough guide to the management and treatment of neurologic and neurosurgical patients is an excellent companion for trainees preparing for the Neurovascular Boards, Neurologists, Neurosurgeons and critical care physicians, alike. Designed by leaders in their field, this thorough guide presents practical, state-of-the-art suggestions for physicians worldwide.
Acute confusional state (ACS) is very common in the intensive care unit (ICU) setting. Most often, it is one of the main reasons a neurology consult is requested in the surgical or medical ICU. Acute confusional states are often used interchangeably when describing metabolic encephalopathy, delirium, ICU psychosis, or septic encephalopathy. Encephalopathy is defined as a subacute global brain dysfunction that is gradual in onset with very broad clinical symptoms, whereas delirium is often described as an acute process. The list of potential causes (Table 32.1) of ACS could be summarized using “Vitamin E” as a mnemonic. In this chapter, we will only focus on management of delirium and toxic metabolic encephalopathy.
Antibody-associated disorders of the central nervous system (CNS) are divided into two broad categories: classic paraneoplastic disorders and autoimmune disorders (i.e. autoimmune encephalitis) . Autoimmune encephalitis is associated with antibodies that bind to cell surface determinants of membrane-associated proteins on neuronal cells (neuronal surface antibody syndrome –NSAb), whereas paraneoplastic syndromes are associated with intracellular neuronal antigens. It can be challenging at times to differentiate between the two syndromes. Patients with NSAb usually present with an acute or subacute symptom onset, with short duration to nadir, and a very good response to immunotherapy . Table 18.1 summarizes some of the characteristics of each. In this chapter, we will focus on the diagnosis and management of autoimmune encephalitis (AE).