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Watching the Brain: an Overview of Neuromonitoring Systems and Their Utility in the Emergency Department

  • Neurologic Emergencies (J Miller, Section Editor)
  • Published:
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Abstract

Purpose of this Review

This review describes strategies for the emergency department setting that help facilitate monitoring of patients with acute neurological injuries. Multiple invasive and non-invasive modalities are available for the emergency physician to utilize as adjuncts to the physical examination and imaging of patients with neurological injuries. The value of these modalities lies in detection of subtle changes that signal early neurological decompensation. This article focuses on the most common devices along with their adoption and implementation into the practice of emergency medicine.

Recent Findings

The field of non-invasive neuromonitoring techniques is rapidly flourishing with an emphasis on portability and reproducibility, enhancing adoption into the practice of emergency medicine. Devices such as the extra-ventricular drain have proven to be of both diagnostic and therapeutic benefit, allowing for both global ICP monitoring and CSF sampling. However, as emergency physicians become more facile in the use of ultrasound, procedures such as optic nerve sheath diameter evaluation and transcranial Doppler assessments add to the availability of bedside neuromonitoring. It is important to note that many of these devices still require further validation.

Summary

The field of neuromonitoring encompasses invasive and non-invasive techniques. While useful, they require further validation to establish standardized protocols that would allow for consistent and reliable implementation in the emergency department.

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Authors and Affiliations

  1. Department of Emergency Medicine and Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA

    Daniel C. Grahf

  2. Department of Emergency Medicine, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA

    Sophia I.J. Binz

  3. Department of Emergency Medicine and Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Wayne State University, CFP 265, 2799 W Grand Blvd, Detroit, MI, 48202, USA

    Tanya Belle & Namita Jayaprakash

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  1. Daniel C. Grahf
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Correspondence to Namita Jayaprakash.

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Grahf, D.C., Binz, S.I., Belle, T. et al. Watching the Brain: an Overview of Neuromonitoring Systems and Their Utility in the Emergency Department. Curr Emerg Hosp Med Rep 8, 25–34 (2020). https://doi.org/10.1007/s40138-020-00208-3

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