Brain Disorders in Critical Illness: Mechanisms, Diagnosis, and Treatment

by Robert D. Stevens (Editor), Tarek Sharshar (Editor), E. Wesley Ely (Editor)

Overview

Brain dysfunction is a major clinical problem in intensive care, with potentially debilitating long-term consequences for post-ICU patients of any age. The resulting extended length of stay in the ICU and post-discharge cognitive dysfunction are now recognized as major healthcare burdens. This comprehensive clinical text provides intensivists and neurologists with a practical review of the pathophysiology of brain dysfunction and a thorough account of the diagnostic and therapeutic options available. Initial sections review the epidemiology, outcomes, relevant behavioral neurology and biological mechanisms of brain dysfunction. Subsequent sections evaluate the available diagnostic options and preventative and therapeutic interventions, with a final section on clinical encephalopathy syndromes encountered in the ICU. Each chapter is rich in illustrations, with an executive summary and a helpful glossary of terms. Brain Disorders in Critical Illness is a seminal reference for all physicians and neuroscientists interested in the care and outcome of severely ill patients.

Product Details

ISBN-13:	9781107424289
Publisher:	Cambridge University Press
Publication date:	09/19/2013
Sold by:	Barnes & Noble
Format:	eBook
File size:	26 MB
Note:	This product may take a few minutes to download.

About the Author

Robert D. Stevens is Associate Professor, Department of Anesthesiology and Critical Care Medicine and Associate Professor of Neurology, Neurosurgery and Radiology-Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Tarek Sharshar is Professor, Department of Intensive Care Medicine, Raymond Poincaré Hospital, University Versailles Saint-Quentin en Yvelines, Garches, France.
E. Wesley Ely is Professor of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine and Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Table of Contents

Foreword; Introduction; Glossary; Part I. Epidemiology and Outcomes: 1. The epidemiology of critical illness brain dysfunction; 2. Cognitive dysfunction following critical illness; 3. Psychiatric disorders following critical illnesses; 4. Functional status and quality of life after critical illness; 5. Delirium and dementia: unraveling the complex relationship; Part II. Behavioral Neurology in the ICU: 6. Cognitive reserve; 7. Neurology of consciousness impairments; 8. Mechanisms of attention and attentional impairment; 9. Neurology of sleep and sleep disorders; 10. Neural basis of fear and anxiety; Part III. Biological Mechanisms: 11. Experimental models of cognitive dysfunction in infection and critical illness; 12. Neurobiological effects of systemic physiological and metabolic insults; 13. Cerebral ischemia and reperfusion; 14. Brain perfusion and autoregulation in systemic critical illness; 15. Delirium and neurotransmitter dysfunction; 16. Neuromodulatory and neurotoxic effects of sedative agents; 17. Neuroimmunological crosstalk in critical illness; 18. Inflammatory mechanisms in chronic neurodegenerative disease: the impact of microglia priming; 19. The neuroendocrine response to critical illness; 20. Autonomic dysfunction in SIRS and sepsis; 21. Sepsis-induced neuronal dysfunction and death; 22. Neuroimmunomodulation in sepsis; Part IV. Diagnosis of Brain Dysfunction: 23. Clinical neurological assessment of the critically ill patient; 24. Bedside assessment of delirium in critically ill patients; 25. Electroencephalography and evoked potentials in critically ill patients; 26. Neuroimaging of delirium; Part V. Preventative and Therapeutic Interventions: 27. Environmental modification; 28. New paradigms in sedation of the critically ill patient; 29. Pharmacological management of delirium; 30. Pharmacogenomics and cerebral dysfunction; 31. Early physical and occupational therapy; 32. Rehabilitation after critical illness; Part VI. Clinical Encephalopathy Syndromes: 33. Drug-induced encephalopathy; 34. Metabolic encephalopathies: inborn errors of metabolism causing encephalopathies in adults; 35. Encephalopathy associated with alcohol or drug withdrawal; 36. Posterior reversible encephalopathy syndrome (PRES): the essential elements; 37. Hypoxic ischemic encephalopathy; 38. Sepsis-associated encephalopathy; 39. Seizures and status epilepticus in critical illness; 40. Encephalopathy and coma in acute liver failure and chronic liver failure; 41. Neurologic complications of cardiac surgery: stroke, encephalopathy, and cognitive decline; Index.

Editorial Reviews

Reviewer: David James Dries, MSE, MD (Regions Hospital)
Description: This multiauthored book describes neurological dysfunction that complicates many forms of critical illness.
Purpose: It provides an overview of brain disorders associated with the ICU routine that patients can exhibit, such as delirium and anoxic encephalopathy.
Audience: Neurologists and intensivists are an appropriate audience for this book, wihich is written by an international group of engineers, medical and surgical intensivists, and neurological scientists.
Features: After presentations on epidemiology that cover cognitive dysfunction, psychiatric disorders, and functional outcomes of critical illness, the book discusses behavioral neurology, including reviews of fear, anxiety, attention and sleep deprivation. A third group of chapters describe biological mechanisms for cognitive dysfunction including delirium, cerebral ischemia, neuroendocrine complications, and autonomic dysfunction. Concluding chapters discuss diagnostic modalities for brain dysfunction, therapeutic interventions, and clinical encephalopathy syndromes. Chapters are clearly written and approximately 10 pages in length. Presentations include a detailed reference list from primary literature with citations dating to within one to two years of publication. Tables are plentiful, but are difficult to read because of the shading they use. Concluding pages include a glossary of terms pertinent to neurological disorders in the ICU. The detailed index includes separate citations for tables.
Assessment: This unique multidisciplinary book collects much of the recent data on functional neurological outcomes in patients with critical illness. As we are beginning to appreciate the broad scope of acute neurological disorders that occur in patients in the ICU setting, the relevance of this work becomes obvious.

Doody's Review Service

"The chapters are concise, well written, and well organized … This very strong and well-referenced basic science text covers a broad range of topics including neuroanatomy, neurophysiology, and biochemistry, and delivers a solid foundation that clinicians can translate to an increased understanding of brain dysfunction at bedside."
Canadian Journal of Anesthesia

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