Index
Module 10 • Neurology
Neurocritical Care
74%
Data Tables
Neurocritical Care
Keaton S. Smetana ~2 min read Module 10 of 20
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Neurocritical Care

Microcirculatory ischemia

Protein catabolism in severe critical illness/immobility may cause muscle wasting.

2Often associated with:

Sepsis

Multiorgan dysfunction

Hyperglycemia

d.Renal failure

Neuromuscular blockade

Duration of vasopressor or corticosteroid therapy

Duration of ICU stay

D.Clinical Impact
1

Limb and diaphragm weakness may persist for weeks to months.

2About 33% of patients with critical illness polyneuropathy ultimately cannot independently ambulate

or breathe.

E.Treatment Considerations
1

No specific treatments have been shown effective.

2Intravenous immunoglobulin may play a role (Lancet Neurol 2008;7:136-44).
3

Intensive glycemic control may reduce critical illness neuropathy.

4

Passive mobilization/early physical therapy in the ICU

5

Daily awakening/less time on the ventilator

6

Limiting risk factors as much as possible

XIV.GUILLAIN-BARRÉ SYNDROME
A.Epidemiology
1

1.11 cases per 100,000 person-years

2Men > women (almost 2:1)
B.Diagnosis/Pathogenesis – Diagnostic tests
1

Bilateral symmetric progressive weakness of limbs

2Generalized hyporeflexia or areflexia
3

Nerve conduction studies may provide a more precise diagnosis.

C.Causes
1

Typically associated with Campylobacter jejuni infection. Also associated with Epstein-Barr virus,

varicella-zoster, and Mycoplasma pneumoniae infections

2Swine flu vaccine in 1976 caused increased risk of Guillain-BarrΓ© syndrome. The same increased risk

has not been associated with other seasonal influenza vaccines.

D.Clinical Impact
1

Progressive weakness over 3–4 weeks

220% of patients remain severely disabled.
3

Mortality rate around 5%

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