Neurocritical Care

Neurocritical care is the comprehensive and multisystem care of critically ill neurologic patients. Neurointensive care issues in the management of subarachnoid hemorrhage, intracerebral hemorrhage, and malignant MCA syndrome are found in this chapter. Cerebral autoregulation may be impaired in acute brain injury, and CBF dysregulates within a CPP range that would otherwise be compensated. In addition to the effects of increased intracranial pressure decreasing cerebral perfusion, an increase in volume can cause displacement of the brain and compression of vital areas. Depending on the location of the increase, several well-characterized herniation syndromes can be differentiated. Secondary neurologic deterioration may also occur from seizures or hydrocephalus in addition to hematoma expansion. Spinal precautions should be maintained until CT imaging of the cervical spine can be obtained and the patient is found to have a stable c-spine.