The quintessential reference for bedside medical management of neurocritical care patients Medical management of patients in the neurocritical care unit (NCCU) often spells the difference between life or death and return to normal function or a lifetime disability. As such, it is vital that patients with life-threatening neurological and neurosurgical illnesses receive prompt diagnosis and rapid interventions in the NCCU. The Jefferson Manual for Neurocritical Care by renowned neurosurgeon Jack I. Jallo, neurointensive care physician Jacqueline S. Urtecho, and distinguished colleagues is a hig.

• The Jefferson Manual for Neurocritical Care
• Title Page
• Copyright
• Contents
• Preface
• Contributors
• 1. Encephalopathy and Delirium
  • 1.1 Encephalopathy
    • 1.1.1 Definition
    • 1.1.2 Causes of Encephalopathy
    • 1.1.3 Diagnosis of Encephalopathy
    • 1.1.4 Treatment of Encephalopathy
    • 1.1.5 Relationship to Delirium
  • 1.2 Delirium
    • 1.2.1 Definition
    • 1.2.2 Duration of Symptoms
    • 1.2.3 Level of Activity
    • 1.2.4 Risk Factors for Delirium
    • 1.2.5 Clinical Assessment
  • 1.3 Treatment
    • 1.3.1 Medications for Agitation
    • 1.3.2 Pharmacologic Management of Hyperactive Delirium and Agitation
    • 1.3.3 Nonpharmacologic Treatments for Delirium
• 2. Cerebrovascular Emergency: Acute Stroke Diagnosis and Management
  • 2.1 Epidemiology
  • 2.2 Etiology
    • 2.2.1 Nonmodifiable Risk Factors
    • 2.2.2 Modifiable Risk Factors
    • 2.2.3 Stroke Subtypes
  • 2.3 Common Clinical Presentations
  • 2.4 Differential Diagnosis for Acute Ischemic Stroke
  • 2.5 Acute Stroke Diagnosis, Treatment, and Management
    • 2.5.1 Stroke Activation
  • 2.6 Criteria for Endovascular Therapy
    • 2.6.1 Neurocritical Care Management of Ischemic Stroke
  • 2.7 Stroke Workup and Management
    • 2.7.1 Post Stroke Complication
• 3. Cerebrovascular Emergency: Spontaneous Intracerebral Hemorrhage (ICH)
  • 3.1 Epidemiology
  • 3.2 Etiologies/Differential Diagnosis
  • 3.3 Common Clinical Presentations
  • 3.4 Neuroimaging
  • 3.5 Treatment
    • 3.5.1 Aggressive Reduction in SBP to Goal of 140
    • 3.5.2 Seizures
    • 3.5.3 Intracranial Pressure
    • 3.5.4 Medical Issues
    • 3.5.5 Coagulopathies
    • 3.5.6 Surgical Options
    • 3.5.7 Craniotomy
    • 3.5.8 Craniectomy
    • 3.5.9 Minimally Invasive Surgical Evacuation
  • 3.6 Prognosis
• 4. Cerebrovascular Emergencies: Aneurysmal Subarachnoid Hemorrhage (SAH)
  • 4.1 Epidemiology
  • 4.2 Risk Factors
  • 4.3 Diagnosis
  • 4.4 Grading System
    • 4.4.1 Hunt and Hess Grade
    • 4.4.2 World Federation of Neurological Surgeons Grade
    • 4.4.3 Modified Fischer Scores
  • 4.5 Management of Subarachnoid Hemorrhage
    • 4.5.1 Early Phase
    • 4.5.2 Late Phase
  • 4.6 Vasospasm, Delayed Neurologic Deterioration (DND), and Delayed Cerebral Ischemia (DCI)
    • 4.6.1 Detection and Management of Vasospasm and DCI
  • 4.7 Hyponatremia and Endocrine Dysfunction
    • 4.7.1 Hyponatremia
    • 4.7.2 Endocrine Dysfunction
• 5. Transfusion Medicine and Anticoagulation
  • 5.1 Introduction
  • 5.2 Anemia in the ICU
  • 5.3 Red Cell Transfusion
    • 5.3.1 Leukocyte Reduction Indications
    • 5.3.2 Washed RBC
    • 5.3.3 Irradiation
    • 5.3.4 Complications of Red Blood Cell Transfusion
    • 5.3.5 Benefits to Transfusion
  • 5.4 Hemoglobin “Triggers”
  • 5.5 Thrombocytopenia
  • 5.6 Prophylaxis Thresholds
    • 5.6.1 Treatment of Bleeding
  • 5.7 Antiplatelet Reversal in Intracranial Hemorrhage
  • 5.8 Coagulation Cascade and Anticoagulants
  • 5.9 Anticoagulants
    • 5.9.1 Warfarin
  • 5.10 Oral Factor Xa Inhibitors
    • 5.10.1 Apixaban, Rivaroxaban, Edoxaban
  • 5.11 Thrombin Inhibitors
    • 5.11.1 Oral
    • 5.11.2 Intravenous
  • 5.12 The Heparins
    • 5.12.1 Unfractionated Heparin
    • 5.12.2 Low-Molecular-Weight Heparin (LMWH)
    • 5.12.3 Fondaparinux
  • 5.13 Deep Vein Thrombosis (DVT) Prophylaxis
• 6. Cerebral Edema and Elevated Intracranial Pressure
  • 6.1 The Basics
    • 6.1.1 Monro-Kellie Doctrine
    • 6.1.2 ICP and Cerebral Perfusion Pressure (CPP)
    • 6.1.3 Intracranial Compliance
    • 6.1.4 ICP Waveforms and Herniation Syndromes
  • 6.2 Cerebral Edema
  • 6.3 Stepwise Approach to the Management of Elevated ICP
  • 6.4 Management of Increased Intracranial Pressure
    • 6.4.1 Tier 1
    • 6.4.2 Tier 2
    • 6.4.3 Tier 3
• 7. Fevers and Infections in the Neuro-ICU
  • 7.1 Brain
    • 7.1.1 Meningitis
    • 7.1.2 Acute Bacterial Meningitis
    • 7.1.3 Aseptic Meningitis
    • 7.1.4 Viral Meningitis
    • 7.1.5 Fungal Meningitis
    • 7.1.6 Ventriculitis
    • 7.1.7 HIV-Related Infections
    • 7.1.8 Empyema
  • 7.2 Spine
    • 7.2.1 Epidural Abscess
    • 7.2.2 Osteomyelitis
  • 7.3 Central Fever
• 8. Treatment of Status Epilepticus in Adults
  • 8.1 Overview and Definitions
  • 8.2 Convulsive Status Epilepticus Management
  • 8.3 Nonconvulsive Status Epilepticus (NCSE)
  • 8.4 Refractory Status Epilepticus (RSE)
  • 8.5 Super Refractory Status Epilepticus (SRSE)
• 9. Trauma
  • 9.1 Acute Spinal Cord Injury
    • 9.1.1 Introduction
    • 9.1.2 Medical Treatment of Acute SCI
    • 9.1.3 Surgical Management of Acute SCI
  • 9.2 Traumatic Brain Injury
    • 9.2.1 Introduction
    • 9.2.2 Management of Elevated ICP
    • 9.2.3 Other Post-TBI Considerations
  • 9.3 Paroxysmal Sympathetic Hyperactivity (PSH)
• 10. Neuromuscular and Other Neurologic Emergencies
  • 10.1 Guillain-Barré Syndrome (GBS)/Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP)
    • 10.1.1 Definition
    • 10.1.2 Epidemiology
    • 10.1.3 Differential Diagnosis
    • 10.1.4 Common Clinical Presentation
    • 10.1.5 Diagnosis
    • 10.1.6 GBS Variants
    • 10.1.7 Ancillary Testing
    • 10.1.8 Complications of GBS
    • 10.1.9 Management
    • 10.1.10 Prognosis
  • 10.2 Myasthenia Gravis
    • 10.2.1 Definition
    • 10.2.2 Epidemiology
    • 10.2.3 Differential Diagnosis
    • 10.2.4 Clinical Presentation of Generalized Myasthenia Gravis
    • 10.2.5 Diagnosis
    • 10.2.6 Management of Myasthenic Crisis
    • 10.2.7 Prognosis
  • 10.3 Botulism
    • 10.3.1 Definition
    • 10.3.2 Epidemiology
    • 10.3.3 Pathophysiology
    • 10.3.4 Differential Diagnosis
    • 10.3.5 Clinical Presentation
    • 10.3.6 Diagnosis
    • 10.3.7 Management
    • 10.3.8 Prognosis
  • 10.4 Organophosphate Toxicity
    • 10.4.1 Definition
    • 10.4.2 Epidemiology
    • 10.4.3 Pathophysiology
    • 10.4.4 Differential Diagnosis
    • 10.4.5 Clinical Presentation
    • 10.4.6 Diagnosis
    • 10.4.7 Management
    • 10.4.8 Prognosis
  • 10.5 Neuroleptic Malignant Syndrome (NMS) and Serotonin Syndrome (SS)
    • 10.5.1 Definition
    • 10.5.2 Epidemiology
    • 10.5.3 Pathogenesis
    • 10.5.4 Differential Diagnosis
    • 10.5.5 Clinical Presentation
    • 10.5.6 Diagnosis
    • 10.5.7 Management
    • 10.5.8 Complications
    • 10.5.9 Prognosis
• 11. Brain Tumor Postoperative Management
  • 11.1 Introduction
    • 11.1.1 Clinical Presentation
    • 11.1.2 Tumor Classification
  • 11.2 Postoperative Care and Complications
    • 11.2.1 Airway Management
    • 11.2.2 Blood Pressure Control and Postoperative Hemorrhage
    • 11.2.3 Seizure Prophylaxis
    • 11.2.4 Venous Thromboembolism Prophylaxis
    • 11.2.5 Antibiotic Prophylaxis and Postoperative Infection
    • 11.2.6 Cerebral Edema
    • 11.2.7 CSF Leak
  • 11.3 Specific Concerns for Sellar and Parasellar Tumors
    • 11.3.1 Hormonal Dysregulation
    • 11.3.2 Pituitary Apoplexy
  • 11.4 Conclusion
• 12. Brain Death in Adults
  • 12.1 Definition of Brain Death
  • 12.2 Clinical Evaluation
    • 12.2.1 Establishing the Proximate Cause of Coma
    • 12.2.2 Clinical Examination to Establish Irreversibility
  • 12.3 Ancillary Tests
  • 12.4 Legal
  • 12.5 Management of the Brain-Dead Patient for Organ Donation
• 13. Sodium Dysregulation
  • 13.1 Terminology
  • 13.2 Hyponatremia Classification
    • 13.2.1 Causes of Hyponatremia
    • 13.2.2 Symptomatic Hyponatremia
  • 13.3 SIADH versus CSW
    • 13.3.1 Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)
    • 13.3.2 Cerebral Salt Wasting (CSW)
    • 13.3.3 SIADH and CSW Diagnosis
  • 13.4 Diagnostic Approach to Hyponatremia
    • 13.4.1 Hyponatremia Treatment: General Principles
    • 13.4.2 Acute Symptomatic Moderate to Severe Hyponatremia
    • 13.4.3 Acute Asymptomatic Moderate Hyponatremia
    • 13.4.4 Severe Chronic Mild-Moderate Hyponatremia
    • 13.4.5 SIADH Treatment
    • 13.4.6 CSW Treatment
    • 13.4.7 Treatment of Hyponatremia in Patients with Subarachnoid Hemorrhage
    • 13.4.8 Treatment of Hyponatremia in Patients with Heart Failure
  • 13.5 Hypernatremia
    • 13.5.1 Central (Neurogenic) Diabetes Insipidus
    • 13.5.2 Nephrogenic Diabetes Insipidus
  • 13.6 Diagnostic Approach to Hypernatremia
    • 13.6.1 Treatment
    • 13.6.2 Central DI Treatment
    • 13.6.3 Nephrogenic DI Treatment
• 14. Nutrition
  • 14.1 Glucose Utilization
  • 14.2 Nutrition in Critical Care
  • 14.3 Nutrition Status
    • 14.3.1 Malnutrition
    • 14.3.2 Refeeding Syndrome
    • 14.3.3 Nutrition-Related Laboratory Tests
  • 14.4 Nutrition Assessment
    • 14.4.1 Calorie Needs
    • 14.4.2 Protein Needs
    • 14.4.3 Nutrition Support
    • 14.4.4 Enteral Nutrition
  • 14.5 Specific EN Considerations
    • 14.5.1 Parenteral Nutrition
  • 14.6 Therapy-Specific Considerations
  • 14.7 Conclusion
• 15. Sedation
  • 15.1 Introduction
  • 15.2 Indications for Sedation
  • 15.3 Complications of Sedation
  • 15.4 Assessment of Sedation
  • 15.5 Choice of Sedative
    • 15.5.1 Propofol (Diprivan)
    • 15.5.2 Midazolam (Versed)
    • 15.5.3 Dexmedetomidine (Precedex)
    • 15.5.4 Fentanyl (Sublimaze)
    • 15.5.5 Ketamine (Ketalar)
• 16. Pain Management in the Neuro-Intensive Care Unit (ICU)
  • 16.1 Introduction
  • 16.2 Modern Strategy of Pain Management in ICU Liberation
  • 16.3 Challenges of Pain Management in Neuro-ICU
  • 16.4 Individualizing Therapy in NICU
    • 16.4.1 Pharmacologic Interventions of Pain
    • 16.4.2 Nonpharmacologic Approach
  • 16.5 Neuro-specific Diseases at Risk for Pain
    • 16.5.1 Pain with SAH
    • 16.5.2 Spondylosis and Disk Herniation
    • 16.5.3 Spasticity
  • 16.6 Ongoing Continuous Pain Monitoring in NICU
    • 16.6.1 Pain Scales
• 17. Advanced Hemodynamic and Neurological Monitoring in the Neuro-ICU
  • 17.1 Hemodynamic Monitoring
    • 17.1.1 Invasive Monitoring: Pulmonary Thermodilution
    • 17.1.2 Less Invasive: Transpulmonary Thermodilution
    • 17.1.3 Minimally Invasive Monitoring: Pulse Contour Analysis
    • 17.1.4 Noninvasive Hemodynamic Monitoring
  • 17.2 Neurological Monitoring
    • 17.2.1 Noninvasive Monitors
    • 17.2.2 Invasive Monitors: Cerebral Oximetry
    • 17.2.3 Cerebral Blood Flow Monitors
    • 17.2.4 Intracranial Pressure Monitoring
• 18. Neuroimaging
  • 18.1 Introduction
  • 18.2 Types of Imaging
    • 18.2.1 Brain Imaging
    • 18.2.2 Spine Imaging
  • 18.3 Advantages and Limitations
    • 18.3.1 Brain Imaging
    • 18.3.2 Spine Imaging
    • 18.3.3 Systemic
• 19. Ventilation Strategies in Neuro-ICU
  • 19.1 Introduction
  • 19.2 Respiratory Failure
    • 19.2.1 Noninvasive Oxygenation and Ventilation
    • 19.2.2 Invasive Mechanical Ventilation
    • 19.2.3 Basic Principles of Mechanical Ventilation
    • 19.2.4 Modes of Ventilation
    • 19.2.5 Initial Ventilator Settings
    • 19.2.6 For Pressure Ventilation
    • 19.2.7 Common Ventilator Problems
    • 19.2.8 Weaning from Ventilator
    • 19.2.9 WHEANS NOT Mnemonic
    • 19.2.10 Extubation Procedure
• Index