This is SIESTA syndrome.  The patient is locked in a cycle of unconsciousness, punctuated with brief episodes of agitation.  Most of the time the patient is sedated to the point of having minimal EEG activity, which may hinder their ability to regain consciousness.  

Historically, many patients admitted with congestion due to heart failure have been treated with furosemide monotherapy.  However, a strategy of furosemide monotherapy has numerous drawbacks:  Furosemide tends to stimulate production of dilute urine, leading to a greater amount of water loss than sodium loss.  Predominant loss of water may cause loss of volume from the […]

This chapter explores some general aspects of neurological infectious diseases, including important historical features and high-risk groups.  It also includes a more general discussion of lumbar puncture performance and interpretation. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

This chapter explores the approach to acute neuromuscular weakness in the ICU, as well as selected disorders.  As with any acute presentation, an organized approach is essential.  Understanding the limitations of various tests is also critical (since there is considerable confusion about this). The IBCC chapter is located 👉 here. The podcast & comments are […]

Management of the a patient following craniotomy focuses on the fundamentals of supportive neurocritical care.  However, special attention is required to unique postoperative complications that may occur (depending on the procedure). The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

Imagine you’re in the ICU and the cuff of an ETT (endotracheal tube) ruptures.  You exchange it for a fresh ETT over a catheter, right?  Easy peasy.  Blind airway exchange over a catheter has been the standard practice in various ICUs that I’ve rotated through.  ETT exchange over a catheter is a simple and effective […]

We throw around the term “nonconvulsive status epilepticus” a lot, and generally think that we know what that is.  However, nonconvulsive status epilepticus is an enormously complex and heterogeneous diagnosis.  This chapter attempts to clarify matters based on the most recent definitions, but in some situations the diagnosis may remain murky. The IBCC chapter is […]

Prior to declaring a patient brain dead, confounding factors which could falsely cause the patient to appear dead must be eliminated.  One important confounder is intoxication.  Failure to recognize that a patient is intoxicated could lead to an incorrect diagnosis of brain death that in turn can lead  to withdrawal of life support – thereby […]

Traumatic spinal cord injury is extremely common.  In addition to the initial management of patients presenting with trauma, we should be comfortable in managing the longer-term sequelae (e.g., autonomic dysreflexia). The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

Most medical myths arose decades ago, prior to the era of modern evidence-based medicine.  When investigating the origin story of those myths, we wind up reading grainy old papers from the 1950s.  Surely, we think, such myths wouldn’t arise today – not in our shiny, interconnected, science-based, hyper-argumentative medical world.  Unfortunately, new myths do continue […]

Question:  Perampanel is an oral antiseizure medication that may occasionally be used for refractory status epilepticus.  It has a half-life of 105 hours.  Different sources recommend three different regimens for its dosing: (a) 18-24 mg load followed by 12 mg/day.(33830480) (b) 32 mg load followed by 12 mg/day.(31565443) (c) 36 mg on day #1, 24 […]

External ventricular drains and lumbar drains will generally be managed primarily by the neurosurgical team.  Nonetheless, some general understanding of their management, data interpretation, and potential complications is extremely helpful. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

The neurological manifestations of COVID is a rapidly moving target.  Different strains of virus, rising levels of immunity, and challenges in sorting out causation from correlation make it impossible to write a perfect chapter on this.  Nonetheless, some patterns and concepts may be helpful. The IBCC chapter is located 👉 here. The podcast & comments […]

Acute demyelinating disorders are not a common cause of ICU admission.  However, these are encountered occasionally (especially acute transverse myelitis, acute disseminated encephalomyelitis, and osmotic demyelination syndrome).  Additionally, some of these disorders may be triggered by COVID, so this chapter will help us understand the neurological manifestations of COVID. The IBCC chapter is located 👉 […]

EEG is an increasingly utilized tool among critically ill patients.  This chapter explores how to interpret the clinical significance of various EEG patterns which are commonly encountered in the ICU. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes