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Harrison's Principles of Internal Medicine, 18e
| Part 12. Critical Care Medicine > Section 3. Neurologic Critical Care > |
Chapter 275. Neurologic Critical Care, Including Hypoxic-Ischemic Encephalopathy, and Subarachnoid Hemorrhage
Sections: Neurologic Critical Care, Including Hypoxic-Ischemic Encephalopathy, and Subarachnoid Hemorrhage: Introduction, Critical Care Disorders of the Central Nervous System, Critical Care Disorders of the Peripheral Nervous System, Subarachnoid Hemorrhage, Further Readings.
Topics Discussed: brain injury, acute management; care of intensive care unit patient.
Excerpt:"Life-threatening neurologic illness may be caused by a primary disorder affecting any region of the neuraxis or may occur as a consequence of a systemic disorder such as hepatic failure, multisystem organ failure, or cardiac arrest (Table 275-1). Neurologic critical care focuses on preservation of neurologic tissue and prevention of secondary brain injury caused by ischemia, edema, and elevated intracranial pressure (ICP). Management of other organ systems proceeds concurrently and may need to be modified in order to maintain the overall focus on neurologic issues.Swelling, or edema, of brain tissue occurs with many types of brain injury. The two principal types of edema are vasogenic and cytotoxic. Vasogenic edema refers to the influx of fluid and solutes into the brain through an incompetent blood-brain barrier (BBB). In the normal cerebral vasculature, endothelial tight junctions associated with astrocytes create an impermeable barrier (the BBB), through which access into the brain interstitium is dependent upon specific transport mechanisms. The BBB may be compromised in ischemia, trauma, infection, and metabolic derangements. Typically, vasogenic edema develops rapidly following injury. Cytotoxic edema refers to cellular swelling and occurs..."
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