Abstract:
:Neuromuscular disorders increasingly are recognized as a complication in patients in the intensive care unit (ICU) and represent a common cause of prolonged ventilator dependency. The distinct syndromes of critical illness myopathy, prolonged neuromuscular blockade, and critical illness polyneuropathy (CIP) may arise as a consequence of sepsis, multi-organ failure, and exposure to various medications--notably, intravenous corticosteroids and neuromuscular blocking agents--but the pathophysiology of these disorders remains poorly understood. More than one syndrome may occur simultaneously, and the distinctions may be difficult in a particular patient, but a specific diagnosis usually can be established after careful clinical, electrodiagnostic, and, when necessary, histological evaluation. For example, asthmatics requiring treatment with corticosteroids and neuromuscular blocking agents may develop an acute myopathy characterized by generalized weakness, preserved eye movements, elevated creatine kinase levels, and myopathic motor units on electromyography (EMG). Muscle biopsy demonstrates distinctive features of thick (myosin) filament loss on ultrastructural studies. Conversely, those with a prolonged ICU course that is complicated by episodes of sepsis with failure to wean from the ventilator, distal or generalized flaccid limb weakness, and areflexia probably have CIP. EMG in these patients demonstrates reduced or absent motor and sensory potentials with neurogenic motor units. Prolonged neuromuscular blockade most commonly occurs in patients with renal failure who have received prolonged infusions of neuromuscular blockers. There is severe flaccid, areflexic paralysis with normal sensation, facial weakness, and ophthalmoparesis that persists for days or weeks after the neuromuscular blockers have been discontinued. Repetitive nerve stimulation shows a decrement of the compound muscle action potential and, in most cases, establishes a disorder of neuromuscular transmission. With the recent epidemic of West Nile virus infection, a clinical syndrome of acute flaccid paralysis with several features indistinguishable from poliomyelitis has emerged. This article critically examines the clinical, electrophysiological, and pathological features of these and other acute neuromuscular syndromes that arise in the context of ICU care and summarizes the current understanding of the pathophysiology and treatment of these disorders.
journal_name
Neurocrit Carejournal_title
Neurocritical careauthors
Gorson KCdoi
10.1385/NCC:3:3:195keywords:
subject
Has Abstractpub_date
2005-01-01 00:00:00pages
195-212issue
3eissn
1541-6933issn
1556-0961pii
NCC:3:3:195journal_volume
3pub_type
杂志文章,评审abstract:BACKGROUND:Oral anticoagulants have been associated with greater hematoma expansion in patients with intracerebral hemorrhage (ICH). The purpose of this study was to determine whether the reported use of antiplatelet agents also results in greater hematoma expansion. METHODS:Retrospective review of patients with spont...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-009-9290-0
更新日期:2010-02-01 00:00:00
abstract:INTRODUCTION:The importance of preoperative response to external ventricular drainage (EVD) for treatment of acute hydrocephalus (HCP) following poor grade (Hunt & Hess grade IV or V) aneurysmal subarachnoid hemorrhage (aSAH) has not been clearly defined. The effect of EVD response on preoperative grade and prognosis i...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-007-0019-7
更新日期:2007-01-01 00:00:00
abstract::A common observation in closed head injuries is the contrecoup brain injury. As the in vivo brain is less dense than the cerebrospinal fluid (CSF), one hypothesis explaining this observation is that upon skull impact, the denser CSF moves toward the site of skull impact displacing the brain in the opposite direction, ...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1385/NCC:1:3:385
更新日期:2004-01-01 00:00:00
abstract:BACKGROUND:There is no uniform definition for cerebral microdialysis (CMD) probe location with respect to focal brain lesions, and the impact of CMD-probe location on measured molecule concentrations is unclear. METHODS:We retrospectively analyzed data of 51 consecutive subarachnoid hemorrhage patients with CMD-monito...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-019-00713-8
更新日期:2020-02-01 00:00:00
abstract:INTRODUCTION:Fever is common and difficult to control in patients with subarachnoid hemorrhage (SAH). We have previously shown an inverse relationship between fever and outcome in patients with SAH. MATERIALS/METHODS:This was a prospective, single-arm, feasibility trial in which nine patients with SAH underwent temper...
journal_title:Neurocritical care
pub_type: 临床试验,杂志文章
doi:10.1385/NCC:1:2:145
更新日期:2004-01-01 00:00:00
abstract::Neurointensive care (NICU) patients experience complex infectious disease challenges. Central nervous system (CNS) infections are difficult to diagnose and treat, and post-neurosurgical patients are vulnerable to a unique set of healthcare-acquired infections (HAI) in addition to those typical of critically ill patien...
journal_title:Neurocritical care
pub_type: 杂志文章,评审
doi:10.1007/s12028-017-0420-9
更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:Fever control plays a key role in therapy of patients with acute brain injury. The infusion of cold saline could serve as an alternative or additional method for targeted temperature management. However, it is difficult to estimate the amount of fluid required to achieve normothermia merely on the basis of b...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-018-0588-7
更新日期:2019-02-01 00:00:00
abstract:BACKGROUND:Improvements in technology play an important role in caring for critically ill patients. One example is the advance in ventilator design to facilitate triggering of mechanical breaths. Minimal changes in circuit flow unrelated to respiratory effort can trigger a ventilator breath and may mislead caregivers i...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-010-9491-6
更新日期:2011-04-01 00:00:00
abstract:BACKGROUND:Neurogenic pulmonary edema (NPE) is an acute life-threatening complication associated with many forms of central nervous system injury. NPE usually appears within minutes to hours after injury and has a high mortality rate if not recognized and treated appropriately. Lung ultrasound quickly provides at the b...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-013-9828-z
更新日期:2013-06-01 00:00:00
abstract:BACKGROUND:Acute hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH); however, attempts to predict shunt-dependent chronic hydrocephalus using clinical parameters have been equivocal. METHODS:Cohort study of aSAH is treated with external ventricular drainage (EVD) placement at our insti...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-019-00886-2
更新日期:2020-08-01 00:00:00
abstract:BACKGROUND:Cerebral edema, which is associated with increased intracranial fluid, is often a complication of many acute neurological conditions. There is currently no accepted method for real-time monitoring of intracranial fluid volume at the bedside. We evaluated a novel noninvasive technique called "Volumetric Integ...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-017-0409-4
更新日期:2018-02-01 00:00:00
abstract:BACKGROUND:Knowing the individual child's risk is highly useful when deciding on treatment strategies, especially when deciding on invasive procedures. In this study, we aimed to develop a new predictive score for children with bacterial meningitis and compare this with existing predictive scores and individual risk fa...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-019-00792-7
更新日期:2020-04-01 00:00:00
abstract::Traumatic brain injury (TBI) is a major cause of death and disability worldwide. In large part critical care for TBI is focused on the identification and management of secondary brain injury. This requires effective neuromonitoring that traditionally has centered on intracranial pressure (ICP). The purpose of this pap...
journal_title:Neurocritical care
pub_type: 杂志文章,评审
doi:10.1007/s12028-014-0048-y
更新日期:2014-12-01 00:00:00
abstract:INTRODUCTION:A 38-year-old man with severe head trauma complicated by paroxysmal severe intracranial pressure elevation associated with tachypnea, tachycardia, diaphoresis, and extensor posturing was diagnosed as suffering from paroxysmal autonomic instability with dystonia (PAID). These events were unresponsive to sta...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-007-0066-0
更新日期:2007-01-01 00:00:00
abstract:BACKGROUND AND AIMS:Lipid peroxidation represents a marker of secondary brain injury both in traumatic and in non-traumatic conditions-as in major neurosurgical procedures-eventually leading to brain edema amplification and further brain damage. Malondialdehyde (MDA), a lipid peroxidation marker, and ascorbate, a marke...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-019-00870-w
更新日期:2020-08-01 00:00:00
abstract:BACKGROUND:This study compares the effect of mild and severe cerebral ischemia on neuronal damage and neurogenesis. METHODS:Sixteen Sprague-Dawley rats, anesthetized with 0.8 vol% halothane in O(2)/air, were subjected to forebrain ischemia by bilateral common carotid artery occlusion plus hemorrhagic hypotension (mean...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-008-9121-8
更新日期:2008-01-01 00:00:00
abstract::Stroke in pregnant women has a mortality rate of 1.4 deaths per 100,000 deliveries. Vascular malformations are the most common cause of hemorrhagic stroke in this population; preeclampsia and other risk factors have been identified. However, nearly a quarter of strokes have an undeterminable cause. Spontaneous intracr...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-018-0501-4
更新日期:2019-02-01 00:00:00
abstract:INTRODUCTION:It is unclear whether the rate of stimulation for somatosensory evoked potentials (SEPs) can influence the presence or absence of cortical responses to median nerve stimulation in comatose patients. If so, this could affect how SEPs are performed and interpreted for prognostication in coma. Our objective w...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-009-9191-2
更新日期:2010-02-01 00:00:00
abstract:BACKGROUND:Subclinical seizures are common in critically ill children and are best detected by continuous EEG (cEEG) monitoring. Timely detection of seizures requires pediatric intensive care unit (PICU) physicians to identify patients at risk of seizures and request cEEG monitoring. A recent consensus statement from t...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-020-01053-8
更新日期:2020-07-21 00:00:00
abstract:BACKGROUND:Decompressive hemicraniectomy (DHC) has proven efficacious for the treatment of malignant middle cerebral artery infarction (mMCAI) only in patients less than 60 years. This study aimed to assess the effectiveness of DHC in patients up to 80. METHODS:This is a prospective, randomized, controlled trail compa...
journal_title:Neurocritical care
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1007/s12028-012-9703-3
更新日期:2012-10-01 00:00:00
abstract:BACKGROUND:There has been growing interest in the use of hypertonic sodium lactate (HSL) solution following traumatic brain injury (TBI) in humans. However, little is known about the effects of HSL on functional deficits with respect to the hyperosmotic nature of HSL. METHODS:We have compared the effects of HSL soluti...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-020-01090-3
更新日期:2020-09-09 00:00:00
abstract:BACKGROUND:Plateau waves are common in traumatic brain injury. They constitute abrupt increases of intracranial pressure (ICP) above 40 mmHg associated with a decrease in cerebral perfusion pressure (CPP). The aim of this study was to describe plateau waves characteristics with multimodal brain monitoring in head injur...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-013-9918-y
更新日期:2014-08-01 00:00:00
abstract:BACKGROUND/OBJECTIVE:In recent years, the noble gas argon (Ar) has been extensively studied for its organ protection properties. While mounting in vitro and in vivo evidence indicates that argon provides neuroprotection in ischemic brain injury, its neuroprotective potential in traumatic brain injury (TBI) has not been...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-020-01104-0
更新日期:2020-09-21 00:00:00
abstract:: ...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-018-0585-x
更新日期:2019-04-01 00:00:00
abstract:BACKGROUND:Angiographic vasculitis affecting the spine has been rarely described. The use of immunosuppression as a primary treatment and a review of the literature is presented. METHODS:Case report. RESULTS:A 61-year-old female presented with sudden onset back pain and headache. The patient was found to have acute s...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-011-9667-8
更新日期:2012-04-01 00:00:00
abstract:BACKGROUND:Infection in the intensive care unit (ICU) empirically requires broad-spectrum antibiotics. Imipenem/cilastatin, often reserved for more serious hospital-acquired infections, is thought to be associated with a higher risk of seizures than other penicillins and carbapenems. We sought to evaluate the safety of...
journal_title:Neurocritical care
pub_type: 杂志文章,评审
doi:10.1007/s12028-008-9170-z
更新日期:2009-01-01 00:00:00
abstract:BACKGROUND:Subarachnoid hemorrhage (SAH) has been associated with pronounced acute sympathetic activation. The purpose of this investigation is to identify demographic, clinical, radiological, and anatomical features of SAH that relate to sympathetic activation. METHODS:Observational study of consecutive Grades 3-5 SA...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-012-9673-5
更新日期:2012-06-01 00:00:00
abstract:BACKGROUND:Delayed ischemic neurological deficits (DINDs) contribute to morbidity and mortality following aneurysmal subarachnoid hemorrhage (SAH). Based on promising preliminary reports, some clinicians routinely administer statins to prevent DINDs. METHODS:Without language restriction, we searched MEDLINE, EMBASE, t...
journal_title:Neurocritical care
pub_type: 杂志文章,meta分析,评审
doi:10.1007/s12028-009-9306-9
更新日期:2010-04-01 00:00:00
abstract::Neurocritical care relies on the continuous, real-time measurement of numerous physiologic parameters. While our capability to obtain such measurements from patients has grown markedly with multimodal monitoring in many neurologic or neurosurgical intensive care units (ICUs), our ability to transform the raw data into...
journal_title:Neurocritical care
pub_type: 杂志文章,评审
doi:10.1007/s12028-013-9872-8
更新日期:2014-02-01 00:00:00
abstract:BACKGROUND:In the postpartum patient, sudden depression of consciousness may be caused by a number of etiologies and can result in serious consequences. Rapid, accurate diagnosis allows for specific treatments that optimize outcome, but diagnosis can be challenging in this population. We present a case of postpartum he...
journal_title:Neurocritical care
pub_type: 杂志文章
doi:10.1007/s12028-012-9742-9
更新日期:2012-12-01 00:00:00