Neurology, Addiction and Psychiatry Conference

Neurocritical care is an area of highly specialized medicine focused on the management of the most critically ill patients with life-threatening neurological conditions, often requiring urgent and aggressive therapy to prevent long-term damage or death. Major neuro-ICUs can be designed to manage various emergencies relating to CNS, such as acute stroke, traumatic brain injury, intracranial hemorrhage, subarachnoid hemorrhage, status epilepticus, and brain infections. The stabilization of the patient, the preservation of neurological function, and prevention of further injury are all the primary aims of neurocritical care.

One of the big problems in neurocritical care is intracranial pressure, or ICP. A brain injury, stroke, or hemorrhage can cause the brain to swell, thereby increasing intracranial pressure. If uncontrolled, this could result in brain herniation and death. Advanced brain monitoring techniques are part of neurocritical care, which very closely follows intracranial pressure and, in particular, cerebral perfusion pressure. Part of invasive monitoring systems includes ICP monitors and brain tissue oxygen monitors, which provide real-time information for treatment decisions.

Patient Care Patients who are admitted to the neurocritical care unit commonly require mechanical ventilation and sedation and aggressive monitoring to protect the brain from further injury. Neurosurgery would also be indicated depending on the case, for instance in evacuating hematoma, decompressive maneuvers and repairing damaged blood vessels. Common surgeries include cases of traumatic brain injury and stroke patients who suffer from the swelling of the brain, such as craniotomy and decompressive craniectomy.

Other complications such as seizures, infections, and hydrocephalus also need to be managed in neurocritical care. Seizure can be prevented or treated using antiepileptic drugs while the infections will be either treated with antibiotics if they are bacterial or antivirals if they are viral, for instance, in the case of encephalitis or meningitis. Prevention and control of secondary complications play an important role in further improving the outcome for long-term survival of critical care patients.

Neuroprotection -- the protection of neural function and limitation of injury spread -- is another key focus area in neurocritical care. Here, blood pressure management, adequate oxygenation, and glucose should be maintained. Advances in therapeutic hypothermia, neuroimaging, and multimodal monitoring open promising new avenues through improvements in protective capabilities of the brain tissue in critical injury time windows and recovery.

Further research coupled with advancing neurocritical care leads to continuous scrutiny of new therapeutic interventions and monitoring technologies for the betterment of survival and neurologic outcomes in patients with acute injuries of the CNS. Neurocritical care teams integrate their work with neurosurgeons, neurologists, and critical care specialists in order to bring about the very best level of care for patients who are faced with extreme neurological crises.