Diabetes in Children
Jack L. Leahy, Nathaniel G. Clark, William T. Cefalu in Medical Management of Diabetes Mellitus, 2000
As an uncommon complication of DKA, cerebral edema can cause acute brain stem herniation and death. It typically develops abrupdy within 2-12 h of starting treatment and manifests as severe headache, vomiting, altered level of consciousness, agitation, delirium, combativeness, restlessness, incontinence, changes in vital signs (bradycardia, increased blood pressure, hypothermia), pupillary changes, papilledema, respiratory arrest, or sudden onset of polyuria from acute diabetes insipidus. Computed tomography (CT) of the brain confirms brain swelling. The decision to intervene should not depend on the results of a CT scan; it should be made on clinical grounds. When cerebral edema is suspected, the following steps should be taken immediately: Administer mannitol 1 g/kg IV over 15 min and repeat as necessary.Reduce the rate of fluid administration.Insert an endotracheal tube and hyperventilate the patient.Intracranial pressure monitoring should be performed in an intensive care unit.
Complications of Liver Transplantation
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
Early after transplantation, alteration in the mental status of the patient can be due to resolving hepatic encephalopathy (which can be monitored by the decline in the ammonia level), but it can also be a consequence of the immunosuppressive therapy, delirium, and sleep deprivation in the intensive care unit and can manifest with disorientation and psychosis. These “metabolic” causes resolve with improving hepatic function, reduction of the immunosuppressive therapy, and transfer of the patient to a non-ICU bed. Seizures can occur in the early postoperative period and are usually associated with electrolyte abnormalities (hypomagnesemia, hypokalemia) or toxic effect of the immunosuppressive medications administered (tacrolimus or cyclosporine toxicity) [18]. Anticonvulsants may be necessary, but many alter the metabolism of concomitantly given immunosuppressive agents. Close monitoring of drug levels is indicated. In patients with fulminant liver failure, cerebral edema may progress during the liver transplant procedure before it subsides. Intraoperative intracranial pressure monitoring and aggressive intracranial pressure management may help prevent death from cerebral edema. Central pontine myelinolysis is a devastating complication seen primarily in patients with severe hyponatremia at the time of transplant [19]. Rapid correction of chronic hyponatremia intraoperatively can provoke this complication. Although some patients recover, many are left with a permanent and profound neurologic impairment.
Treatment Of Lightning Injury
Christopher J. Andrews, Mary Ann Cooper, Mat Darveniza, David Mackerras in Lightning Injuries: Electrical, Medical, and Legal Aspects Editors, 1992
An X-ray of the chest may be helpful in the moderately or severely injured patient. Cervical spine films should be ordered for anyone who has had a loss of consciousness, a history of being thrown, cranial burns, contusions, or change in mentation. Other films may be indicated by the patient’s history and physical examination. If there is evidence of intracranial injury or edema, computerized tomography or nuclear magnetic resonance scanning are indicated, and intracranial pressure monitoring may be helpful. Obviously, operable causes of intracranial injury require operative intervention, depending on the general expectation for the survival of the patient.
Brain ultrasound for diagnosis and prognosis in the neurological intensive care unit: a mini review for current development
Published in Neurological Research, 2019
Haomeng Zhu, Xiaokun Geng, Gary B. Rajah, Paul Fu, Huishan Du
Increased intracranial pressure is one of the clinical symptoms caused by many disease etiologies. Intracranial pressure monitoring plays a very important role in critically ill patients and may improve the understanding of the disease and guide clinical treatment. In order to maintain the necessary brain function, adequate cerebral blood flow and appropriate intracranial pressures are critical [32]. At present, minimally invasive ventricle monitoring equipment has been the gold standard for monitoring ICP. Currently, there is a lack of non-invasive techniques to accurately monitor intracranial pressure and replace invasive monitoring. Animal experiments and clinical studies have confirmed that TCD values are a close approximation of the measured intracranial pressure. With a constant blood vessel diameter, the cerebral blood flow velocity is directly proportional to the cerebral blood flow. The change of the TCD spectrum morphology and the change of blood flow parameters can reflect the increase of intracranial pressure.
Safety of treating acute liver injury and failure
Published in Expert Opinion on Drug Safety, 2022
Miren García-Cortés, Aida Ortega-Alonso, Raúl J. Andrade
Development of HE brain edema and intracranial hypertension (ICH) may occur in one-third of cases who progress to grade 3 or 4 HE [145]. More commonly encountered clinical signs are sustained clonus, pupillary abnormalities and increase in muscular tone. Late signs of this complication are arterial hypertension, bradicardia, and mydriasis. Trans-cranial Doppler in combination with arterial Ammonia levels, is a useful noninvasive monitoring tool in less severe cases of neurologic impairment, in order to decide which patients need ICP monitor insertion. However, invasive intracranial pressure monitoring should be considered in more severe cases with high risk of ICH [1]. Mannitol or hypertonic saline should be administered when ICH is detected to increase serum osmolarity, and therefore reduce intracraneal pressure [146,147]. A prospective ramdomized clinical trial showed that mannitol and hypertonic saline have similar reduction in ICP and short‐term survival with significantly reduced rebound cerebral edema with the later. Besides, mannitol has shown an increased risk of kidney injury, thus 3% hypertonic saline seems to be a better modality for management of raised ICP in ALF patients [148].
Incidence of neurobehavioral side effects associated with levetiracetam compared to phenytoin in traumatic brain injury patients
Published in Brain Injury, 2021
Jerika V. Nguyen, Tian Yaw, Holly Gratton
A significantly higher percentage of patients in the levetiracetam group sustained an epidural hematoma (10 [10.5%] vs. 25 [23.8%], p = .016). In addition, patients who received phenytoin were more likely to have a longer inpatient length of stay (8.9 days vs. 7.2 days, p = .015) and ICU length of stay (4.8 days vs. 3.2 days, p = .006). Intracranial pressure monitoring was performed for 31.5% of patients, which was not different between groups (p = .226). Similarly, there were no differences in decompressive craniectomy (18 [18.9%] vs. 15 [14.3%], p = .447), hematoma evacuation (19 [20%] vs. 22 [21%], p > .999), or craniotomy (24 (25.3%] vs. 23 [21.9%], p = .619) rates.
Related Knowledge Centers
- Cerebrospinal Fluid
- Intracranial Pressure
- Traumatic Brain Injury
- Stroke
- Glasgow Coma Scale
- Intracerebral Hemorrhage
- NON-Invasive Measurement of Intracranial Pressure