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388

Index

 

Aquaporin-4, 215

Bickerstaff’s brainstem encephalitis, 170

Arachnoid villi, 92

Blepharospasm, 64

Arousability, 40

Blood pressure, 45, 216

Arousal

Blood tests, 77

abnormalities of, 183–184

Blood-brain barrier, 202

deficits in, 111

Bobbing, ocular, 69t, 71–72, 162

definition of, 183

Brain

Arousal system

cardiovascular control pathways in, 47f

compressive lesions effect on, 90–95

cerebral perfusion pressure, 43

structural processes that impair, 9

oxygen deprivation effects, 46

Arteriovenous malformations, 140

regionally selective injuries that affect, 374–376

Ascending arousal system

temperature fluctuations in, 259

behavioral state switching, 22, 24–25

traumatic injury to. See Traumatic brain injury

description of, 11–22, 19f

venous sinus thrombosis of, 154, 156

distortion of, 101

Brain abscess, 141–142, 142f, 143t

interconnectivity of, 22

Brain death

pathways of, 39

apnea, 334–335, 335t

Aseptic meningitis, 134t

brainstem function findings, 333–335

Aspergillus meningitis, 133

cerebral scintigraphy evaluations, 336

Asterixis, 195–197

characteristics of, 8–9

Astrocytes

criteria for, 331–333, 332t

description of, 198

decision making regarding, 378

glutamate-induced glycolysis in, 199f

definition of, 8

hepatic encephalopathy pathology in, 224

determination of, 331–333

Astrocytomas, 141

electroencephalography evaluations,

Asystole, 213

337–339, 338t

Ataxia, 113

etiology of, 332–333, 333t

Ataxic breathing, 50f, 52

evoked potential measurements, 337–338

Atropine-scopolamine, 242t

laboratory tests, 335–338

Attention, 185

magnetic resonance angiography evaluations, 336

Autonomic neuropathy, 234

medical extension of life, 331–332

Axonal shearing, 161

motor activity, 334

 

 

motor responses, 332, 339

Bacterial encephalitis, 262–263

neurologic examination, 332

Bacterial leptomeningitis, acute, 262–265

ocular movements in, 334

Bacterial meningitis

organ donation considerations, 331

acute, 132–133, 133t, 263

organ survival, 338–339

chronic, 133, 265–266

pitfalls in diagnosis of, 338–339

treatment of

in profound anesthesia, 338

 

algorithm for, 316f

pupillary findings, 333–334

 

corticosteroids, 322

reflex activity, 334

 

regimen for, 325

sensory activity, 334

Barbiturates

signs of, 333–335

anesthesia using, 205–206, 323

transcranial Doppler ultrasonography

delirium caused by, 242t

evaluations, 336

Baroreceptor reflex arc, 46

vestibulo-ocular responses, 339

Basal forebrain, 13b–14b

Brainstem

Basal ganglionic hemorrhages, 137

compression of, 91, 145, 150

Basilar artery

lesions of, 30f, 115–116

description of, 96, 99f

rostrocaudal deterioration of, 102

posterior cerebral arteries from, 153

trauma to, 116

Basilar artery occlusion

upper, injury to, 33–34

description of, 163

upward herniation, 102–103

distal, 152–154

vascular destruction disorders of

prodromal symptoms in, 214t

basilar artery occlusion, 163–166

signs and symptoms of, 164t

basilar migraine, 168

Basilar migraine, 168

brainstem hemorrhage, 166–168

Battle’s sign, 40, 121

description of, 163

Behavioral state switching, 22, 24–25

posterior reversible leukoencephalopathy

Behc¸et’s disease, 115, 276

syndrome, 168–169, 169t

Benzodiazepines

Brainstem auditory-evoked responses, 354

‘‘Amytal interview’’ using, 307

Brainstem gliomas, 51

description of, 242t, 245

Brainstem hemorrhage, 166–168

overdose of, 316

Brainstem infarction, 165t

Berger, Hans, 12

Brainstem tumors, 170

 

Index

389

Breathing

Cerebral angiography, 335–336

 

abnormalities of, 46t, 46–47

Cerebral artery infarction, 153f

 

apneustic, 51–52

Cerebral autosomal dominant arteriopathy with

 

ataxic, 50f, 52

subcortical infarcts and leukoencephalopathy, 168,

cluster, 50f

276

 

Kussmaul, 75–76

Cerebral biopsy, 273

 

physiology of, 47–48

Cerebral blood flow

 

rhythmic, 49

brain death evaluations, 335–336

 

Bremer, Frederic, 12

during cardiac arrest, 206

 

Brudzinski’s sign, 40, 263

hypoglycemia effects on, 204

 

Burst neurons, 13b

hypoxia effects on, 211

 

 

increases in, 45

 

Calcium abnormalities

during neural activity, 198, 200

 

hypercalcemia, 256–257

normal levels of, 198

 

hypocalcemia, 257–258

reductions in

 

Caloric vestibulo-ocular responses, 65, 68

causes of, 200

 

Canavan’s disease, 114

in clouding of consciousness, 6

 

Cancer, 238–240

global, 200

 

Carbon dioxide narcosis, 231

loss of consciousness caused by, 201

 

Cardiopulmonary arrest

regional, 200

 

coma after

regulation of, 43, 202

 

outcomes, 352

Cerebral cortex

 

pitfalls in evaluation of, 354–355

description of, 25

 

mortality rates for, 343

diffuse, bilateral destruction of, 114

 

Cardiopulmonary bypass surgery, 218

hypoxia effects on, 31f

 

Cardiopulmonary resuscitation, 206–207, 207f

Cerebral edema, 263

 

Carotid ischemic lesions, 152

Cerebral glucose consumption, 204

 

Case law, 376–377

Cerebral herniation, 263–265

 

Cataplexy, 20b

Cerebral ischemia, multifocal, 215–216

 

Catatonia, 299, 302–304, 303t

Cerebral malaria, 217

 

Central homunculus, 27

Cerebral metabolic rate

 

Central Horner’s syndrome, 57–58

description of, 204

 

Central nervous system infections

in minimally conscious state patients, 374

 

acute bacterial leptomeningitis, 262–265

Cerebral metabolism, 374–375

 

diagnosis of, 262

Cerebral oxygen consumption, 6

 

differential diagnosis, 270t

Cerebral perfusion pressure

 

prognosis after, 356

decreased, 93

 

Central neurogenic hyperventilation, 50f, 51

description of, 43, 45

 

Central pontine myelinolysis, 171

intracranial pressure effects on, 93

 

Central sleep apnea, 52

Cerebral scintigraphy, 336

 

Central transtentorial herniation

Cerebral vascular lesions, 137, 138b–139b

 

clinical findings of, 107–110

Cerebral venous hypoxia, 211

 

description of, 101–102

Cerebrospinal fluid

 

diencephalic stage of, 107–108, 108f–109f

in herpes simplex encephalitis, 268

 

medullary stage of, 109

herpes simplex encephalitis findings,

 

midbrain stage of, 107–108

157, 157t

 

pontine stage of, 108–109

lumbar puncture evaluations, 81–82

 

Central venous thrombosis, 169t

meningitis findings, 134, 134t

 

Cerebellar abscess, 149–150, 150t

obstruction of, 91

 

Cerebellar cognitive affective syndrome, 306–307

subarachnoid hemorrhage evaluation, 130

 

Cerebellar hematoma, 323

systemic lupus erythematosus findings, 275

 

Cerebellar hemorrhage

Cerebrospinal fluid pressure, 92

 

algorithm for, 148f

Cerveau isole, 12

 

brainstem compression by, 145

Chemoreceptors, 188

 

clinical findings of, 146t

Cheyne-Stokes respiration, 49–51, 50f, 75, 187

 

computed tomography findings, 147

Chloromas, 144

 

description of, 138b–139b

Choline, 80

 

hypertension and, 145–146

Cholinergic neurons, 15

 

surgical interventions for, 147, 148f

Chronic liver failure, 224

 

Cerebellar infarction, 139b, 148–149, 324

Chronic meningitis, 133, 265–266

 

Cerebellar mass, 91

Chronic relapsing pancreatitis, 231

 

Cerebellar mutism, 306

Chronic subdural hematoma, 123–124

 

Cerebellar tonsils, 100

Ciliospinal reflex, 54, 57, 59

 

Cerebellar tumors, 91, 150

Circulatory assessments, 313

 

Cerebellopontine angle lesion, 91

Closed head traumatic brain injury, 159–161

 

390 Index

Clouding of consciousness

cerebral oxygen consumption reductions associated with, 6

definition of, 6 Cluster breathing, 50f Cocaine, 210, 242t

Cofactor deficiency, 223–224 Cognition, 185, 373 Cognitive deficits, 7

Cold caloric stimulation, 193 Collier’s sign, 64

Coma

causes of, 4t definition of, 7 depth of, 7

diagnosis of, 9, 309–311 drug-induced causes of. See Drug

intoxications duration of, 346, 349 history-taking, 9 hypoglycemic, 210 locked-in syndrome vs., 7

metabolic. See Metabolic coma premonitory causes of, 39–40 prognosis in, 343–344

sleep vs., 5, 25

structural. See Structural coma thalamic causes of, 33

Coma cocktail, 316

Coma of unknown origin, 332, 338 Coma scales

description of, 41b FOUR Score, 41b, 311

Glasgow Coma Scale. See Glasgow Coma Scale

Community-acquired meningitis, 132–133, 133t Compressive lesions

angiogenesis caused by, 94 arousal system affected by, 90

consciousness impairments caused by, 88–90

diencephalon, 90 infratentorial, 142–143

local tissue ischemia induced by, 94 mechanism of action, 89–90 midbrain, 90

posterior fossa, 90–91 sites of, 89t supratentorial, 120 types of, 121t

Computed tomography

brain abscess findings, 142f cerebellar hemorrhage findings, 147 description of, 78, 79f

epidural hematoma findings, 122f hepatic encephalopathy evaluations, 225 intracerebral hemorrhage findings, 136f meningioma evaluation, 127

meningitis evaluations, 133–134, 135t subarachnoid hemorrhage findings,

130, 130f

subdural hematoma evaluations, 125, 125f supratentorial mass lesion evaluations, 321

Computed tomography angiography, 78 Concussion, 161

Confusion Assessment Method for the Intensive Care Unit, 184t

Conjugate lateral deviation, 69–70 Conjugate vertical deviation, 70 Consciousness

altered state of. See Altered state of consciousness

clouding of, 6 components of, 5 content of, 5 definition of, 5

loss of. See Loss of consciousness Convergence nystagmus, 71 Conversion hysteria, 299 Conversion reactions, 299–302 Corneal erosions, 317

Corneal reflex, 64 Corneal responses, 64, 320 Corneal trauma, 64 Cortical blindness, 77 Corticosteroids

Cushing’s syndrome treated with, 235–236 in diabetes mellitus patients, 233 herniation treated with, 322

meningitis treated with, 134, 322 Coup-contrecoup injury, 159 Craniopharyngiomas, 128 Creatine, 80

Creutzfeldt-Jakob disease, 266, 277 Cushing reflex, 44, 97b

Cushing’s disease, 236 Cushing’s syndrome, 235–236 Cutaneous reflexes, 72 Cytotoxic edema, 94f, 95

Decerebrate rigidity, 74–75, 77, 324 Decompressive craniotomy, 152, 323 Decorticate rigidity, 74, 77, 324 Delayed encephalopathy, 161–162, 219 Delirium

acute states, 282–284 with agitation, 6, 317

‘‘Amytal interview’’ for, 307–308, 327 attention disorders in, 185 characteristics of, 181

definition of, 6 dementia and, 8 drug withdrawal, 283 drug-induced, 284

electroencephalogram evaluations, 304 intensive care unit, 283–284 postoperative, 283

signs and symptoms of, 6 Delirium tremens, 283 Delusions, 6

Dementia, 7–8

Depressant drug coma, 241, 245t, 357 Descending sympathoexcitatory pathways, 44 Destructive lesions

description of, 88, 114 infratentorial, 162–163 sites of, 89t

supratentorial. See Supratentorial destructive lesions

types of, 121t

 

Index

391

Desynchronized sleep, 16b

Edinger-Westphal nucleus, 56–57

 

Dexamethasone, 322

Elderly

 

Diabetes mellitus

cerebellar infarction in, 148

 

autonomic neuropathy caused by, 234

hyperglycemia in, 222

 

coma in, 232t

meningitis in, 133, 263

 

definition of, 232

traumatic brain injury in, 345

 

hyperglycemia in, 233–234

Electrocerebral inactivity, 337

 

hyperosmolality in, 232

Electroencephalography

 

hypoglycemia in, 234

alpha pattern, 82

 

renal insufficiency caused by, 234

brain death determinations, 337–339, 338t

 

stupor in, 232t

catatonia evaluations, 304

 

Diabetic encephalopathy, 222

delirium evaluations, 304

 

Diabetic ketoacidosis, 187, 232–234, 309

history of, 12

 

Diabetic lactic acidosis, 233

indications for, 82

 

Dialysis disequilibrium syndrome, 229

sinusoidal appearance, 13b

 

Diencephalic stage, of central transtentorial

traumatic brain injury-related abnormalities, 346

 

herniation, 107–110, 108f–109f

Electromyogram, 16b

 

Diencephalon

Embolism

 

autoimmune disorders that affect, 115

to brain, 218

 

compression of, 90

from cardiopulmonary bypass surgery, 218

 

destruction disease of, 114–115

fat, 217–218

 

injuries to

pulmonary, 214

 

description of, 32–33

Empyema, 126–127, 144

 

pupillary responses after, 58

Encephale isole, 12

 

lateral displacement of, 97b, 100

Encephalitis, viral

 

lesions of, 88

acute, 266–269

 

Diffuse axonal injury, 161

acute toxic encephalopathy during, 266, 269–271

 

Diffusion tensor imaging, 371f

cerebral biopsy for, 273

 

Dipping, ocular, 69t, 71–72

classification of, 266

 

Disorientation, 185

description of, 156–157, 157t

 

Disseminated intravascular coagulation, 217

herpes simplex encephalitis, 157, 157t,

 

Distal basilar occlusion, 152–154

267–269, 315

 

Distractibility, 185

overview of, 266–267

 

Do not resuscitate order, 376

parainfectious encephalomyelitis, 266, 271–273

 

Doll’s eye response

Encephalitis lethargica, 12

 

in catatonia, 303

Encephalomyelitis, acute disseminated, 157–158

 

in central transtentorial herniation,

Encephalopathy

 

108f–109f

delayed postanoxic, 219

 

definition of, 65

diabetic, 222

 

Dopamine, 209

Hashimoto’s, 237

 

Dorsal midbrain compression, 102,

hepatic

 

110–112

diagnosis of, 225

 

Dorsal raphe nuclei, 15

hyperventilation associated with, 224

 

Drop attacks, 213–214

mild, 227

 

Drowning, 260

onset of, 224

 

Drug intoxications. See also Overdoses

pathology of, 224

 

acetaminophen, 245, 326

pupillary findings in, 225

 

antidepressants, 241, 245–246

hypernatremic, 256

 

antidotes for, 251t

hyponatremic, 254t

 

benzodiazepines, 242t, 245

hypoxic-ischemic, 352–354

 

evaluation of, 324

metabolic. See Metabolic encephalopathy

 

heroin, 243

pancreatic, 231–232

 

list of, 242t

pulmonary, 231

 

management of, 326

toxic, 262, 266, 269–271

 

opioids/opiates, 242t, 243

uremic, 227–229

 

overview of, 240, 240t

Wernicke’s

 

proconvulsants, 247t

causes of, 223

 

prognosis after, 357

description of, 11

 

sedatives, 240–241, 243–245

thiamine prophylaxis, 77, 223, 313

 

testing for, 240, 241t

End artery hemorrhages, 137, 139

 

Drug withdrawal delirium, 283

Epidural abscess, 126–127, 144

 

Drug-induced delirium, 284

Epidural hematoma, 121–123, 143–144

 

Drunkenness. See Ethanol intoxication

Epilepsy, 280–281, 315

 

Dural tumors, 120, 127, 144

Epileptic seizures, 213–214, 304–306

 

Duret hemorrhages, 102, 103f

Ethanol intoxication, 246, 248

 

392 Index

Ethylene glycol, 250 Evoked potentials

brain death determinations, 337–338, 338t description of, 82–83

somatosensory

in anoxic-ischemic encephalopathy, 354t description of, 346

vegetative state evaluations, 359–360 Examination

airway, 42–43 circulation, 43–46

coma scales. See Coma scales corneal responses, 320

eye opening, 319 history-taking, 39–40, 317–318 motor responses, 320 neurologic, 9, 318–319 oculocephalic responses, 319 overview of, 38–39, 39t physical, 40

pupillary reactions, 319 respiration. See Respiration skeletal muscle tone, 320 tendon reflexes, 320

of unconscious patient, 317–320 verbal responses, 319 vestibulo-ocular responses, 65, 320

Excitatory amino acids, 114 Extradural hematoma, 309–310 Eye(s)

conjugate lateral deviation, 69–70 conjugate vertical deviation, 70 nystagmoid jerks of, 71–72 opening of, 319

Eye movements

in brainstem infarcts, 165t conjugate lateral deviation, 69–70 conjugate vertical deviation, 70 nonconjugate eye deviation, 70 oculocephalic stimulation of, 65 pathways for, 60f

periodic alternating, 71 resting, 69

roving, 70–71 skew deviation, 70

spontaneous, 69, 69t Eyelids, 64

Falcine herniation, 100 Falx cerebri, 95–96, 96f–97f Families

considerations for, 379–380 functional communication with, 380

Fat embolism, 217–218

Fatal familial insomnia, 115, 277–278 Fever, 260–261, 282–283 Flumazenil, 316

Flunitrazepam, 248

Focal continuous epilepsy, 315 Focal ischemia, 207–208 Foramen magnum, 100 Forced duction of globe, 68 Forebrain

arousal of, 14

mesopontine tegmentum, 14

Foster-Kennedy syndrome, 92 FOUR Score, 41b, 311 14–3–3, 277

Fourth ventricle compression, 148 Fractional loss of consciousness, 5, 27 Frontal eye fields, 62

Frontoparietal hemorrhage, 138b

GABAA receptors, 18b, 209, 246 Gag reflex, 334

Galvanic stimulation, 65 Gamma-aminobutyric acid, 209 Gamma-aminobutyric acid-ergic neurons, 205 Gamma-hydroxybutyrate, 209

Gastric lavage, 326 General anesthesia

description of, 205–206

malignant hyperthermia associated with, 262

Gerstmann-Strau¨ ssler disease, 277 GHB, 248

Glasgow Coma Scale description of, 42b

in traumatic brain injury prognosis, 345, 345t

Glasgow Outcome Scale, 344, 344t Glia, 198

Glial fibrillary acidic protein, 347 Gliomas, 140–141

Gliomatosis cerebri, 278–279 Global ischemia, 206–207 Globe

forced duction of, 68 lateral movement of, 60–61

Globus pallidus, 28 Glucagon-like peptide-1, 53 Glucose

brain utilization of, 202 cerebral consumption of, 204 deprivation of, 202 measurement of, 313 metabolism of, 202–205

Glucose disorders

hyperglycemia, 203, 222–223, 313 hypoglycemia, 203–205, 220–222, 313

Glut-1, 202

Glutamate, 80, 210–211, 223 Glutamine, 80 Glutethimide, 59

Gnosis, 186 Granulomas, 141–142

Granulomatous angiitis, 156, 273–274 Grasp reflex, 72

Great vein of Galen, 102 Guillain-Barre´ syndrome, 76–77, 170

Hallucinations, 6

Hashimoto’s encephalopathy, 237 Headaches

increased intracranial pressure as cause of, 92 in infratentorial mass lesions, 323

in subdural hematoma, 124 supratentorial mass lesions and, 320

Heart rate, 45 Heatstroke, 260–261

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