DISEASES TREATED IN A NEURO ICU

In a neuro-ICU Neurocritical care trained Physicians and Nurses care for acutely ill patients with diseases of the brain, spinal cord and nerves that often have associated medical problems complicating their care.  Below is basic information on some commonly treated ailments in the neuro-ICU. Please consult your physician for more information about any of these conditions.

Subarachnoid Hemorrhage (SAH)

SAH is a type of bleeding that occurs in the membranes that surround the brain and is typically due to head injury or the rupture of an aneurysm. An aneurysm is an abnormal ballooning of an artery causing the artery to weaken and rupture. Smoking, high blood pressure and cocaine use can contribute to the formation and growth of aneurysms. Most aneurysms rupture when patients reach age 40-60. Aneurysms should be repaired as soon as possible either with surgery or endovascular coiling. The next 3-14 days after aneurysm rupture represents the vasospasm period. During this time, other brain vessels can become irritable and spasm or clench up. Spasm limits the amount of blood that can pass through that vessel to supply nourishment to the brain. This can at times lead to strokes. Neurointensivists carefully watch patients for the development of vasospasm so they can intervene with medical or endovascular treatments to prevent stroke. Most subarachnoid hemorrhage patients will spend at least 1 week in the ICU. Outcome after SAH depends primarily on the patient’s age, his or her clinical status at presentation (depth of coma etc,) and the amount of bleeding that occurred at the time of aneurysm ruptured.

Intracerebral Hemorrhage (ICH)

ICH is another type of bleeding in the brain that occurs within the brain tissue itself. ICH often related to high blood pressure, vascular malformations (abnormal tangle of blood vessels) in the brain tissue, brain tumors that bleed, blood thinners, or an entity known as amyloid angiopathy which implies vessel abnormality that occurs in older patients. Some types of ICH are treated with surgery, though most are not. Intracerebral hemorrhages can rupture into the fluid filled spaces within the brain called the ventricles. When this occurs patients often need drainage of the blood and spinal fluid through a tube placed through the skull and into the ventricle. Prognosis after ICH depends on the size of the bleed, the presence of intraventricular blood, the clinical condition of the patient at presentation, the age of the patient and the location of the blood.

Traumatic Brain Injury (TBI)

TBI can result from blunt trauma (falls, motor vehicle accidents etc.), or penetrating trauma (such as gunshot wounds, stab wounds etc.). There are many types of brain injury following head trauma including bleeds around the brain such as subdural or epidural hemorrhage and injury to the brain tissue itself such as contusions or bruising of the brain. Rapid acceleration- deceleration injury (as occurs in motor vehicle accidents) can cause shearing of the brain tissue which is called diffuse axonal injury. Elevated pressure in the skull is a serious consequence of TBI and must be treated rapidly and aggressively. Many types of TBI are treated by surgically removing the blood (subdural, epidural hemorrhage) or part of the skull to treat the pressure in the brain. Special medications can also be given to lower brain pressure.

Ischemic Stroke

Ischemic stroke occurs when arteries that provide blood and oxygen to the brain get clogged, preventing blood flow. Clots may travel to the brain from the heart or other blood vessels or may form at an atherosclerotic plaque in a blood vessel. High blood pressure may contribute to abnormalities in small blood vessels leading to strokes. It is important to recognize the warning signs of stroke (FAST: Face weakness, Arm weakness, Speech difficulties, Time of symptoms), as well as vision abnormalities, difficulty walking etc. because special clot-busting medications can be delivered to treat ischemic stroke if given within a narrow time window. Clot busters can either be given through the veins or directly into the arteries via an angiogram at certain specialized facilities. Large strokes may require surgery to treat swelling of the brain.

Brain Tumors

There are many different types of brain tumors, including primary brain tumors (glioblastoma multiforme, astrocytoma, oligodendroglioma, meningioma, pituitary adenoma) and metastatic brain tumors which are tumors that have spread to the brain from other parts of the body (lung, breast, kidney). Depending on the location of the brain tumor, patients will have different neurologic deficits such as speech difficulty, weakness, numbness, personality changes, or difficulty walking. Most brain tumors are treated with a combination of surgical resection, chemotherapy, and radiation therapy.

Status Epilepticus

Seizures are abnormal electrical discharges that propagate through the brain. Seizures can occur in patients with epilepsy, but also can be provoked by brain injury from trauma, strokes, tumors, infection, alcohol abuse, metabolic imbalance or certain drugs. Status epilepticus is defined as uncontrolled and persistent seizures. Status epilepticus can lead to brain injury and must be treated without delay. Patients typically require brain monitoring called electroencephalogram (EEG) to help treat status epilepticus. A variety of different medications are available for the treatment of status epilepticus.

Neuromuscular Disorders

Certain diseases of the muscle (myopathy) and nerves (Guillain-Barre Syndrome) and the junction between the muscles and nerves (Myasthenia Gravis) can cause profound weakness. Some patients require the mechanical respiratory support of a ventilator. Some of these neuromuscular disorders can be treated with intravenous gammaglobulin or plasmapheresis and many patients recover their strength over a period of days to months.

Infections of the Brain and Spinal Cord

An infection of the membranes surrounding the brain is called meningitis, while an infection involving the brain tissue itself is called encephalitis. Infections may be caused by bacteria, viruses, fungi or parasites. Organized pockets of infection within the brain are called abscesses. Most infections are treated with a combination of antibiotics. Some abscesses require surgical drainage. Patients with heart infections such as endocarditis are at particular risk for infection spreading to the brain. 

Spinal Cord Injury

Spinal cord injury can occur from trauma, infections, inflammation, metabolic deficiencies, infection, strokes of the spinal cord or injury to the bones or discs that surround the cord. Some types of spinal cord injuries require surgical treatment, while others require treatment with steroids, intravenous gamma globulin or plasmapheresis.
The information posted here by the Neurocritical Care Society or any third party is intended for informational purposes only, should not be considered medical advice and is not intended to replace consultation with a qualified medical professional.  You should consult your medical provider directly regarding your health and any specific medical questions you may have.