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.
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.