CT imaging is the ideal technique for initial evaluation of neurocritical care patients. It is robust, reliable and relatively easy to interpret. Its ability to diagnose hemorrhage, bony fractures, brain edema and herniation in short scanning times makes it an ideal technique for neurological emergencies. The imaging equipment, normal anatomy and imaging findings in pathologies like infarct, hemorrhage, trauma and hydrocephalus are reviewed in the article.
How to cite this article:
Hrishi AP, Sethuraman M. Cerebrospinal Fluid (CSF) Analysis and Interpretation in Neurocritical Care for Acute Neurological Conditions. Indian J Crit Care Med 2019; 23 (S2):115-119.
Cerebrospinal fluid (CSF) is a clear fluid circulating in the intracranial and spinal compartments. Under normal conditions, the composition of CSF remains constant. However, in various neurological disease especially in acute conditions, the composition, quantity and its pressure can be altered. By measuring the levels of various CSF components using relevant techniques, diagnosis, severity and prognostication of neurological conditions like infections, subarachnoid hemorrhage, demyelinating conditions, tumor like conditions, etc. can be done. In this review, alterations in CSF components and its relevance to the emergency care physician to help in the management of patients are enumerated.
Raised intracranial pressure (rICP) syndrome is seen in various pathologies. Appropriate and systematic management is important for favourable patient outcome. This review describes the stepwise approach to control the raised ICP in a tiered manner, with increasing aggressiveness. The role of ICP measurement in the assessment of cerebral autoregulation and individualised management is discussed. Although a large amount of research has been undertaken for the management of raised ICP, there still remain unanswered questions. This review tries to put together the best evidence in a succinct manner.
Neuro psychiatric illnesses are commonly recognised these days in the intensive care especially with the increasing aging population and more intensive care admissions. However they are still inadequately diagnosed and treated disease entities as a majority of these patients do not seek the help of specialists psychiatrists Of course the number of drugs used in psychiatry has explosively increased in recent years. As a corollary to this, the phenomenon of drug- drug interaction between psychiatric drugs and other drugs has come to the forefront. Drug- drug interaction (DDI)) is the response (pharmacological or clinical) of altered drug effects or increase in adverse effects when two or more drugs are used simultaneously1,2 This effect may be different from the usual action of the individual drugs when used alone. Potential drug- drug interaction (PDDI) are those where theoretically there may be an interaction between the drugs but have not clinically occurred.1,2
Cognitive dysfunction is a common complication in primary or metastatic brain tumors and can be correlated to disease itself or various treatment modalities. The symptoms of cognitive deficits may include problems with memory, attention and information processing. Primary brain tumors are highly associated with neurocognitive deficit and poor quality of life. This review discusses the pathophysiology, risk factors and assessment of cognitive dysfunction. It also gives an overview of the effect of anesthetics on postoperative cognitive dysfunction and its management.
Neurocritical care is an ever growing specialty with paradigm changes being the norm. Some of the established practices like triple H therapy for SAH and steroids in pyogenic meningitis have seen major changes in published evidence. This article evaluates the evidence published over the last few years which resulted in a change in the authors approach to and practice of neuro intensive care.
The purpose of research is to gather data, which can then be used to inform decision-making. Data can be of various types and an understanding of this is crucial for its proper analysis and interpretation. In this article, we look at various types and distributions of data, and methods to summarize this data.