Neurologic and NeurosurgicalNeurologic and NeurosurgicalEmergencies in the ICUEmergencies in the ICU

Thomas P. Bleck, MD, FCCMThomas P. Bleck, MD, FCCM

Louise Nerancy Eminent Scholar in NeurologyProfessor of Neurology, Neurological Surgery, and Internal MedicineDirector, Neuroscience Intensive Care UnitThe University of Virginia

OverviewOverview

Altered consciousness and comaIncreased intracranial pressureNeurogenic respiratory failureStatus epilepticusAcute stroke intervention

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Intracerebral hemorrhage

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Subarachnoid hemorrhageHead traumaSpinal cord injury

Altered Consciousness and ComaAltered Consciousness and Coma

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Consciousness requiresarousal(coming from the brainstemreticular formation) andcontent(the cerebral hemispheres)Alterations in consciousness stem from:

•Disorders affecting the reticular formation•Disorders affectingbothcerebral hemispheres•Disorders affecting the connections between the brainstem and thehemispheres