Coma and Intensive Care Neurology

  • Daniel F. Hanley
  • Anish Bhardwaj
  • John A. Ulatowski
  • Alex Razumovsky
  • Marek A. Mirski


Neurocritical care is a subspecialty that has grown during the past 15 years. Critical care is care that is rendered in an acute and emergent setting in which the absence of care is associated with severe disability or death. The critical care concept evolved out of the need to render time-dependent emergent therapies in acute respiratory failure during the polio epidemics and for arrhythmia experienced by heart attack victims. Critical care grew rapidly in the 1970s to provide supportive care for the sickest patients with cardiologic, pulmonologic, and gastrointestinal disorders. In the 1980s the analogous subsets of neurologic and neurosurgical patients began to be identified. Neurocritical Care Units are now populated with head trauma victims, subarachnoid hemorrhage patients, the small numbers of patients who have treatable stroke, and patients with infectious disorders, including meningitis, encephalitis, and the parainfectious diseases, such as Guillain-Barré syndrome and myasthenia gravis. This chapter illustrates the time dependence and therapeutic complexities associated with these patients.


Status Epilepticus Thrombotic Thrombocytopenic Purpura Domoic Acid Viral Encephalitis Clinical Neurology 
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  1. 1.
    Ramsay MAE, Savege TA, Simpson BRJ, Goodwin R: Controlled sedation with alphaxalone-alphadolone. BMJ 1974, 2: 656–659.PubMedCrossRefGoogle Scholar
  2. 2.
    Mirski MA, Muffelman B, Ulatowski JA, et al.: Sedation for the critically ill neurologic patient. Crit Care Med 1995, 23:2038–2053.PubMedCrossRefGoogle Scholar
  3. 3.
    Teasdale G, Jennett B: Assessment of coma and impaired consciousness. Lancet 1974, 1: 878–881.Google Scholar
  4. 4.
    Ropper AH: Neurological and Neurosurgical Intensive Care, edn 3. New York: Raven Press; 1993.Google Scholar
  5. 5.
    Wijdicks EFM: Neurology of Critical Illness. Philadelphia: FA Davis, 1995.Google Scholar
  6. 6.
    Hacke W, ed: Neurocritical Care. Berlin: Springer-Verlag, 1994.Google Scholar
  7. 7.
    Grotta JC: Management of the Acutely Ill Neurological Patient. New York: Churchill Livingstone, 1993.Google Scholar
  8. 8.
    Classification of cerebrovascular disease III. Special report from the National Institute of Neurological Disorders and Stroke. Stroke 1990, 21: 637–676.Google Scholar
  9. 9.
    Mohr JP, Barnett HJM: Classification of Ischemic Strokes. In Stroke: Pathophysiology, Diagnosis and Management. Edited by Barnett HJM, Mohr JP, Stein BM, Yatsu FM. New York: Churchill Livingstone; 1986: 281–292.Google Scholar
  10. 10.
    Kittner SJ, Sharkness CM, Sloan MA, et al.: Infarcts with a cardiac source of embolism in the NINDS Stroke Data Bank. Neurology 1992, 42:299–302.Google Scholar
  11. 11.
    Mohr JP, Caplan LR, Melski JW, et al.: The Harvard registry of cases hospitalized with stroke. Neurology 1978, 28:754–762.Google Scholar
  12. 12.
    Kunitz S, Gross CR, Heyman A, et al.: The pilot stroke data bank: definition, design, data. Stroke 1984, 15:740–746.Google Scholar
  13. 13.
    Fisher MC: Principles of Diagnosis and Management of Occlusive Cerebrovascular Disease. In Neurological and Neurosurgical Intensive Care, edn 3. Edited by Ropper HH. New York: Raven Press; 1993.Google Scholar
  14. 14.
    Brucher R, Russell D: Methods and Clinical Potential. Neurosonology. Edited by Tegeler CH, Babikian VL, Gomez CR. St. Louis: Mosby-Year Book; 1995: 231–234.Google Scholar
  15. 15.
    Bryan RN, Levy LM, Whitlow WD, et al.: Diagnosis of acute cerebral infarction: comparison of CT and MR imaging. AJNR 1992, 8:245–263.Google Scholar
  16. 16.
    Yuh WT, Crain MR, Loes DJ, et al.: MR imaging of cerebral ischemia: findings in the first 24 hours. AJNR 1991, 12:621–629.Google Scholar
  17. 17.
    Mathews VP, Barker PB, Bryan RN: Magnetic resonance evaluation of stroke. Magnetic Resonance Quarterly 1992, 4: 245–263.Google Scholar
  18. 18.
    Aaslid R, ed: Transcranial Doppler Sonography. New York Springer-Verlag; 1986.Google Scholar
  19. 19.
    Hereda P, Traubner P, Bujdakova J: Short-term prognosis of stroke due to occlusion of internal carotid artery based on transcranial Doppler ultrasonography. Stroke 1992, 23: 1069–1072.CrossRefGoogle Scholar
  20. 20.
    Halsey JH Jr: Prognosis of acute hemiplegia estimated by transcranial Doppler ultrasonography. Stroke 1988, 19: 648–649.PubMedCrossRefGoogle Scholar
  21. 21.
    Von Kummer R, Bozzao L, Manelfe C: Early CT diagnosis of hemispheric brain infarction. Berlin: Springer-Verlag; 1995.CrossRefGoogle Scholar
  22. 22.
    Del Zoppo GJ: Thrombolytic therapy in acute stroke: recent experience. Cerebrovasc Dis 1993, 3: 256–263.CrossRefGoogle Scholar
  23. 23.
    Brott TL: Thrombolytic therapy. Neurol Clin North Am 1992, 10: 219–232.Google Scholar
  24. 24.
    Brandt T, Muller-Kuppers M, von Kummer R, et al.: Thrombolytic therapy for acute basilar artery occlusion: predictors for recanalization and outcome. Stroke 1996, 27:875–881.Google Scholar
  25. 25.
    Hacke W, Zeumer H, Ferbert A, et al.: Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke 1988, 19:1216–1222.Google Scholar
  26. 26.
    Zeumer H, Freitag H-J, Zanella F, et al.: Local intra-arterial fibrinolytic therapy in patients with stroke: urokinase versus recombinant tissue plasminogen activator (r-TPA). Neuroradiology 1993, 35:159–162.Google Scholar
  27. 27.
    Bockenheimer St, Reinhuber F, Mohs C: Intraarterielle thrombolyse himversorgender Gefäße. Radiologe 1991, 31: 210–215.Google Scholar
  28. 28.
    Becker KJ, Monsein LH, Ulatowski JA, et al.: Intraarterial thrombolysis in vertebrobasilar occlusion. AJNR 1996, 17:1–8.Google Scholar
  29. 29.
    Brass LM: Clinical Syndromes of Intracerebral Hemorrhage. In Intracerebral Hemorrhage. Edited by Feldmann E. Armonk, NY: Futura Publishing; 1994: 223–255.Google Scholar
  30. 30.
    Kelly MA: Management of Intracerebral Hemorrhage. In Atlas of Cerebrovascular Disease. Edited by Gorelick PB. Philadelphia: Current Medicine; 1996:20. 1–20. 10.Google Scholar
  31. 31.
    Kistler JP, Gress DR, Crowell RM: Subarachnoid Hemorrhage Due to a Ruptured Saccular Aneurysm. In Clinical Atlas of Cerebrovascular Disorders. Edited by Fisher M. London: Mosby-Wolfe; 1994:12. 1–12. 14.Google Scholar
  32. 32.
    Origitano TC: Treatment of Aneurysmal Subarachnoid Hemorrhage. In Atlas of Cerebrovascular Disease. Edited by Gorelick PB. Philadelphia: Current Medicine; 1996:19. 1–19. 11.Google Scholar
  33. 33.
    Dorsch NW, King MT: A review of cerebral vasospasm in aneurysmal Subarachnoid hemorrhage. Part I: Incidence and effects. J Clin Neurosci 1994, 1: 19–26.PubMedCrossRefGoogle Scholar
  34. 34.
    Martin N, Khanna R, Rodts G: The Intensive Care Management of Patients with Subarachnoid Hemorrhage. In Neurocriticallntensive Care. Edited by Andrew BT. New York: McGraw-Hill; 1993: 291–310.Google Scholar
  35. 35.
    Seiler R, Newell DW: Subarachnoid hemorrhage and vasospasm. In Transcranial Doppler. Edited by Newell DW, Aaslid R. New York: Raven Press; 1992: 101–107.Google Scholar
  36. 36.
    Griffin DE: Encephalitis, Myelitis, and Neuritis. In Principles and Practice of Infectious Diseases, edn 4. Edited by Mandell GL, Bennett JE. New York: Churchill Livingstone; 1995: 874–881.Google Scholar
  37. 37.
    Hanley DF, Glass JD, McArthur JC, Johnson RT: Viral Encephalitis and Related Conditions. In Atlas of Infectious Diseases, vol 3. Edited by Mandell GL, Bleck TP. Philadelphia: Current Medicine; 1995:3. 1–3. 36.Google Scholar
  38. 38.
    Mateos-Mora M, Ratzan KR: Acute Viral Encephalitis. In Infectious of the Nervous System. Edited by Schlossberg D. New York: Springer-Verlag; 1990: 105–134.CrossRefGoogle Scholar
  39. 39.
    Whitley RJ, et al.: Herpes simplex encephalitis: Clinical assessment. JAMA 1982, 247:317–320.Google Scholar
  40. 40.
    Whitney RJ, Schlitt M: Encephalitis Caused by Herpesviruses, Including B Viruses. In Infections of the Central Nervous System. Edited by Scheld RJ, Whitley RJ, Durack DT. New York: Raven Press; 1991: 53–55.Google Scholar
  41. 41.
    Johnson RT: Current Therapy in Neurologic Disease, edn 2. Philadelphia: BC Decker; 1987.Google Scholar
  42. 42.
    Cascino GD: Nonconvulsive status epilepticus in adults and children. Epilepsia 1993, 34 (suppl 1): S21 - S28.PubMedCrossRefGoogle Scholar
  43. 43.
    Lowenstein DH, Alldredge BK: Status epilepticus at an urban public hospital in the 1980s. Neurology 1993, 43: (3 Pt 1): 483–488.PubMedCrossRefGoogle Scholar
  44. 44.
    Treiman DM: The role of benzodiazepines in the management of status epilepticus. Neurology 1990, 40: 32–42.PubMedGoogle Scholar
  45. 45.
    Lothman E: The biochemical basis and pathophysiology of status epilepticus. Neurology 1990, 40 (suppl 2): 13–23.PubMedGoogle Scholar
  46. 46.
    Treiman DM: Status Epilepticus. In Current Therapy in Neurological Diseases, edn 2. Edited by Johnson RT. Philadelphia: BC Decker; 1987: 38–42.Google Scholar
  47. 47.
    Treiman DM: Generalized convulsive status epilepticus in the adult. Epilepsia 1993, 34: S2 - S11.PubMedCrossRefGoogle Scholar
  48. 48.
    Yaffe K, Lowenstein DH: Prognostic factors of pentobarbital therapy for refractory generalized status epilepticus. Neurology 1993, 43: 895–900.PubMedCrossRefGoogle Scholar
  49. 49.
    Kumar A, Bleck TP: Intravenous midazolam for the treatment of refractory status epilepticus. Crit Care Med 1992, 20: 483–488.PubMedCrossRefGoogle Scholar
  50. 50.
    Lowenstein DH, Aminoff MJ, Simon RP: Barbiturate anesthesia in the treatment of status epilepticus: clinical experience with 14 patients. Neurology 1988, 38: 395–400.PubMedCrossRefGoogle Scholar
  51. 51.
    Mirski MA, Williams MA, Hanley DF: Prolonged pentobarbital and phenobarbital coma for refractory generalized status epilepticus. Crit Care Med 1995, 23: 400–403.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2003

Authors and Affiliations

  • Daniel F. Hanley
  • Anish Bhardwaj
  • John A. Ulatowski
  • Alex Razumovsky
  • Marek A. Mirski

There are no affiliations available

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