There are significant cardiac abnormalities observed following subarachnoid hemorrhage (SAH) that varies depending upon the grade of SAH, but correlate with the degree of elevation of cardiac troponin I (cTnI). These effects are likely mitigated through sympathetic and parasympathetic dysfunction that results from global cerebral dysfunction following SAH. This chapter presents a case study of a 54-year-old male with no significant past medical history who suddenly developed a thunderclap headache. The patient underwent an uneventful ventriculoperitoneal shunt placement and after 2 more weeks in the neurosurgical intensive care unit (ICU) was transferred to the general care ward. The histopathology of neurogenic cardiac lesions is distinct from the coagulation necrosis observed following myocardial infarction. Both sympathetic overactivity and parasympathetic dysfunction result in a pro-arrhythmogenic state as well that worsens electrocardiogram (ECG) changes associated with myocardial necrosis.

Acute liver failure (ALF) is a rare clinical syndrome characterized by coagulopathy and hepatic encephalopathy. Multisystem organ failure secondary to sepsis and cerebral herniation secondary to increased intracranial pressure (ICP) are the leading causes of death. The decision to place an ICP monitor to facilitate goal-directed management of intracranial hypertension remains controversial. Drug-induced hepatotoxicity remains the leading cause of ALF in the USA with acetaminophen overdose constituting approximately 50% of all cases. The prognosis for spontaneous recovery of liver function decreases with increasing severity of encephalopathy. The coagulopathy of ALF is multifactorial, including impaired synthesis of clotting factors and fibrinogen, increased peripheral consumption, and thrombocytopenia. While placement of an ICP monitor to facilitate goal-directed management of intracranial hypertension may insure that cerebral perfusion is preserved, the risks of intracranial hemorrhage from ICP monitor placement and blood product administration must be considered.