Seizures in Critical Care (eBook)
XVI, 432 Seiten
Humana Press (Verlag)
978-1-60327-532-3 (ISBN)
The first edition of Seizures in Critical Care: A Guide to Diagnosis and Therapeutics, which appeared in 2005, filled an important need in the ar- mentarium of the neurological, neurosurgical, and medical intensivists who deal with seriously ill patients in the ICU setting. Unlike epilepsy, as it u- ally presents in the outpatient department, seizures in ICU patients are nearly always secondary phenomena that signify that something is seriously amiss in very ill patients with primary medical or surgical disease. The job of the int- sivist is to identify the cause of the seizure or seizures, examine the myriad of potential contributing factors, and provide appropriate management and tre- ment that takes all aspects of the patient's illness into consideration. As in the first edition, Dr. Varelas and his associates recognize the extreme importance of prompt recognition, diagnosis, and sophisticated management of seizures in this group of seriously ill patients. Dr. Varelas has now recollected his group of contributors and produced a new and up to date compendium of what one needs to know in order to work effectively in this difficult and demanding area. A welcome addition to the new edition is the chapter by Friedman and Hirsch on the role of continuous monitoring in the ICU which is essential for the diagnosis and treatment of nonconvulsive seizures as these may be the most common form of seizures in this setting but are often missed in the evaluation of patients in stupor or coma.
0001096886.pdf 1
Anchor 1 6
Anchor 2 5
Anchor 3 8
Anchor 4 11
0001096871.pdf 14
Chapter 1 14
Presentation and Pathophysiology of Seizures in the Critical Care Environment: An Overview 14
1.1. Introduction 14
1.2. Cellular Pathphysiology of ICU Seizures 20
1.3. Clinical Manifestations and Diagnosis 23
1.4. Overview of Status Epilepticus 25
1.5. Paroxysmal Lateralizing Epileptiform Discharges (PLEDS) 28
1.6. Conclusion 29
References 29
0001096872.pdf 34
Chapter 2 34
Diagnosing and Monitoring Seizures in the ICU: The Role of Continuous EEG for Detection and Management of Seizures in Critica 34
2.1. Introduction 34
2.2. How To Monitor 35
2.3. Data Analysis 39
2.4. Who To Monitor 43
2.5. What To Look For 44
2.6. Why Monitor 49
2.7. How Long To Monitor 50
2.8. Future Directions 50
2.9. Summary 53
References 55
0001096873.pdf 61
Chapter 3 61
Stroke and Critical Care Seizures 61
3.1. Introduction 61
3.2. Seizures After Ischemic Stroke 62
3.2.1. Clinical Studies 62
3.2.2. Status Epilepticus 72
3.2.3. Pathophysiology 73
3.2.4. EEG Findings 77
3.2.5. Neuroimaging 78
3.2.6. Seizures Post Stroke in the Young and the Elderly 81
3.2.7. Treatment of Post-Ischemic Stroke Seizures 82
3.3. Intracerebral Hemorrhage (ICH) 85
3.3.1. Clinical Studies 85
3.3.2. SE Following ICH 90
3.3.3. Pathophysiology of Seizures Post ICH 91
3.3.4. Treatment of Seizures Post ICH 91
3.4. Subarachnoid Hemorrhage 93
3.4.1. Clinical Studies 93
3.4.2. Treatment of Seizures after SAH 98
3.5. Arteriovenous Malformations 103
3.5.1. Clinical Studies 103
3.5.2. Treatment of AVM-Related Seizures 105
3.6. Reperfusion–Hyperperfusion Syndrome 109
3.7. Cerebral Vein and Dural Sinus Thrombosis 113
3.7.1. Clinical Studies 113
3.7.2. Treatment of Seizures Related to CVT 117
References 118
0001096874.pdf 131
Chapter 4 131
Traumatic Brain Injury and Seizures in the ICU 131
4.1. Introduction 131
4.2. Incidence of Seizures in Traumatic Brain Injury 132
4.3. Experimental Approaches to Posttraumatic Seizures 136
4.4. Pathophysiology of Posttraumatic Seizures 137
4.5. Diagnosis of Seizures 138
4.6. Treatment of Posttraumatic Seizures 140
4.7. Outcome of Seizures Complicating TBI 143
4.8. Conclusions 143
References 144
0001096875.pdf 149
Chapter 5 149
Brain Tumors and ICU Seizures 149
5.1. Introduction 149
5.2. Incidence 150
5.3. Clinical Presentation 151
5.4. Pathophysiology 152
5.5. Evaluation of Patients with ICU Seizures 155
5.6. Treatment 158
5.6.1. Prophylactic Administration of Antiepileptics 158
5.6.2. Treatment of Seizures in the ICU 161
5.7. Outcome 164
References 164
0001096876.pdf 169
Chapter 6 169
Global Hypoxia–Ischemia and Critical Care Seizures 169
6.1. Introduction 169
6.2. Epidemiology 170
6.3. Pathophysiology 170
6.3.1. Pathological and Chemical Changes in Hypoxic–Ischemic Injury and Seizures 170
6.3.2. Myoclonus in Hypoxic–Ischemic Coma 172
6.3.3. Lance–Adams Syndrome 172
6.4. Clinical Presentation 172
6.4.1. Generalized Tonic-Clonic Seizures 172
6.4.2. Focal and Complex Partial Seizures 173
6.4.3. Myoclonus 173
6.4.4. Lance–Adams Syndrome 174
6.5. Laboratory Investigation 175
6.5.1. Electroencephalography 175
6.5.2. Electromyography 176
6.5.3. Somatosensory-Evoked Potentials 177
6.5.4. Brain Imaging 178
6.5.5. Cerebrospinal Fluid Analysis 178
6.6. Differential Diagnosis 178
6.7. Treatment 180
6.7.1. General Considerations 180
6.7.2. Simple and Complex Partial Seizures 181
6.7.3. Generalized Tonic-Clonic Seizures 181
6.7.4. Myoclonus 181
6.7.5. Prophylactic Anticonvulsant Use 181
6.7.6. Lance–Adams Syndrome 182
6.7.7. Supportive Management 182
6.8. Prognosis and Outcomes 182
6.9. Hypothermia and Seizures after Resuscitation from Cardiac Arrest 183
References 186
0001096877.pdf 191
Chapter 7 191
Seizures in Fulminant Hepatic Failure, Multiorgan Failure, and Endocrine Crisis 191
7.1. Introduction 191
7.2. Organ Failure 192
7.2.1. Hepatic Failure 192
7.2.1.1. Treatment of Seizures in Hepatic Failure 194
7.2.2. Renal Failure 196
7.2.2.1. Introduction 196
7.2.2.2. Uremic Encephalopathy 197
7.2.2.3. Dialysis Dysequilibrium Syndrome 198
7.2.2.4. Subdural Hematoma 198
7.2.2.5. Dialysis Dementia 198
7.2.2.6. Drug Induced Seizures 198
7.2.2.7. Treatment of Seizures Related to Renal Failure 199
7.3. Endocrine Disease 200
7.3.1. Thyroid Disease 200
7.3.2. Diabetes Mellitus and Glycemic Homeostasis 201
7.3.3. Pituitary Hormones 202
7.3.4. Sex Hormones 203
7.3.5. Parathyroid Hormones 203
7.3.6. Adrenal Glands 204
References 208
0001096878.pdf 214
Chapter 8 214
Seizures in Organ Transplant Recipients 214
8.1. Incidence of Seizures in Transplant Patients 214
8.1.1. Liver Transplant 214
8.1.2. Bone Marrow Transplant 215
8.1.3. Heart Transplantation 216
8.1.4. Kidney Transplantation 216
8.1.5. Lung Transplantation 217
8.1.6. Pancreas Transplantation 217
8.2. Clinical Evaluation of Patients 217
8.3. Etiology of Seizures in Transplant Patients 218
8.3.1. Immunosuppression Drugs 219
8.3.2. Cyclosporin 220
8.3.3. Tacrolimus (FK-506) 221
8.3.4. Muromonab-CD3 (OKT3) 221
8.3.5. Carmustine and Busulfan 221
8.4. Diagnostic Evaluation 221
8.5. Management of Seizures 222
8.5.1. Antiepileptic Drugs 223
8.5.2. AED Interaction with Immunosuppression 224
8.5.2.1. Management Considerations in Kidney Failure Patients 225
8.5.2.2. Management Considerations in Liver Failure Patients 225
8.6. Case Studies 225
8.6.1. Case Study: #1 225
8.6.2. Case Study: #2 226
References 228
0001096879.pdf 230
Chapter 9 230
Extreme Hypertension, Eclampsia and Critical Care Seizures 230
9.1. Introduction 230
9.2. Hypertension and Pregnancy 231
9.2.1. Pre-eclampsia and Eclampsia 231
9.2.1.1. Epidemiology 232
9.2.1.2. Pathophysiology 232
9.2.1.3. Clinical Presentation 232
9.2.1.4. Electrographic and Radiographic Features 233
9.2.1.5. Management 233
9.2.2. HELLP Syndrome 235
9.3. Hypertensive Encephalopathy 235
9.3.1. Epidemiology 235
9.3.2. Clinical Features 235
9.3.3. Pathophysiology 236
9.3.4. Electrographic and Radiographic Features 237
9.3.5. Management of Hypertensive Encephalopathy 237
9.4. Posterior Leukoencephalopathy Syndrome 239
9.4.1. Clinical Features 239
9.4.2. Pathophysiology 239
9.4.3. Radiological Features 239
9.4.4. Management 240
References 240
0001096880.pdf 243
Chapter 10 243
Infection or Inflammation and ICU Seizures 243
10.1. Introduction 243
10.2. CNS Infectious Disorders 244
10.2.1. Meningitis 244
10.2.2. Encephalitis 246
10.2.2.1. Japanese Encephalitis 247
10.2.2.2. Herpes Simplex Encephalitis 248
10.2.2.3. West Nile Virus Encephalitis 249
10.2.3. Brain Abscess 250
10.2.4. Intracranial Extra-Axial Pyogenic Infections 251
10.2.5. Ventriculitis 252
10.2.6. HIV Infection and Seizures 253
10.3. Vasculitides 257
10.3.1. Necrotizing Vasculitides 257
10.3.1.1. Wegner’s Granulomatosis 258
10.3.1.2. Polyarteritis Nodosa 258
10.3.1.3. Churg–Strauss Syndrome 258
10.3.2. Vasculitides Associated with Connective Tissue Disease 258
10.3.2.1. SLE 258
10.3.2.2. Rheumatoid Arthritis 261
10.3.2.3. Scleroderma 261
10.3.2.4. Sjogren’s Syndrome (SS) 261
10.3.2.5. Mixed Connective Tissue Disease (MCTD) 261
10.3.3. Vasculitis Associated with Other Systemic Diseases 261
10.3.3.1. Behçet Disease 261
10.3.3.2. Sarcoidosis 262
References 264
0001096881.pdf 272
Chapter 11 272
Electrolyte Disturbances and Critical Care Seizures 272
11.1. Introduction 272
11.2. Mechanisms for Ion Regulation and Effects of Concentration Changes 273
11.2.1. Potassium 273
11.2.2. Acid–Base Status 273
11.2.3. Osmotic Effects 274
11.3. Sodium Imbalance 274
11.3.1. Hyponatremia 274
11.3.1.1. Acute Hyponatremia in the ICU 278
11.3.2. Hypernatremia 279
11.4. Hypomagnesemia 280
11.5. Disorders of Calcium Homeostasis 283
11.5.1. Hypocalcemia 283
11.5.2. Hypercalcemia 284
11.6. Hypophosphatemia 285
11.7. Summary 286
References 287
0001096882.pdf 292
Chapter 12 292
Alcohol-Related Seizures in the Intensive Care Unit 292
12.1. Introduction 292
12.2. Alcohol Withdrawal Syndrome 293
12.2.1. Minor Alcohol Withdrawal 293
12.2.2. Alcohol Hallucinosis 293
12.2.3. Delirium Tremens 293
12.3. Alcohol-Related Seizures 294
12.3.1. Differential Diagnosis 295
12.3.1.1. Sample Case 298
12.3.2. Alcohol-Related Status Epilepticus 298
12.4. Pathophysiology of Alcohol-Related Seizures 300
12.5. Comorbid Medical Conditions 302
12.6. Evaluation 303
12.7. Treatment 304
12.7.1. Supportive Care 305
12.7.2. Benzodiazepines 307
12.7.3. Antiepileptic Medications 308
12.7.4. Antihypertensive Agents 309
12.7.5. Haloperidol 310
12.7.6. Propofol 310
12.7.7. Barbiturates 310
12.7.8. Intravenous Alcohol 310
12.7.9. Alcohol-Related Status Epilepticus 310
12.7.10. Outpatient Treatment 311
References 311
0001096883.pdf 316
Chapter 13 316
Drug-Induced Seizures in Critically Ill Patients 316
13.1. Introduction 316
13.1.1. Epidemiology 317
13.1.2. Risk Factors 318
13.1.3. Prevention 318
13.2. Causative Agents 319
13.2.1. Analgesics 320
13.2.1.1. Opioids 320
13.2.1.2. Salicylates 322
13.2.2. Anesthetics 322
13.2.2.1. General Anesthetics 322
13.2.2.2. Local Anesthetics 323
13.2.3. Antiepileptic Agents 324
13.2.4. Antimicrobial Agents 326
13.2.4.1. Beta-Lactams 327
13.2.4.2. Carbapenems 328
13.2.4.3. Fluoroquinolones 329
13.2.4.4. Isoniazid 329
13.2.4.5. Metronidazole 330
13.2.5. Antiviral Agents 330
13.2.6. Bronchodilators 331
13.2.7. Immunosuppressive Agents 332
13.2.8. Chemotherapeutic Agents 333
13.2.9. Psychotropic Agents 333
13.2.9.1. Antipsychotic Agents 334
13.2.9.2. Antidepressants 335
Tricyclic Antidepressants 336
Selective Serotonin Reuptake Inhibitors 336
Monoamine Oxidase Inhibitors 337
Bupropion 337
Miscellaneous Antidepressants 337
13.2.9.3. Lithium 337
13.2.10. Stimulants 338
13.2.11. Drug Withdrawal 339
13.2.12. Miscellaneous Agents 339
13.3. Treatment 340
13.3.1. Summary 340
References 340
0001096884.pdf 350
Chapter 14 350
Critical Care Seizures Related to Illicit Drugs and Toxins 350
14.1. Introduction 350
14.2. Illicit Drugs 350
14.2.1. Opiates 351
14.2.2. Sedatives and Hypnotics 352
14.2.3. Stimulants 353
14.2.4. Solvents 353
14.2.5. Hallucinogens 354
14.3. Epileptogenic Environmental Toxins 354
14.3.1. Marine Toxins 354
14.3.2. Mushroom and Plant Toxins 355
14.3.3. Carbon Monoxide 356
14.3.4. Heavy Metals 357
14.3.4.1. Introduction 357
14.3.4.2. Lead 357
14.3.4.3. Mercury 358
14.3.4.4. Tin 358
References 359
0001096885.pdf 364
Chapter 15 364
Management of Status Epilepticus and Critical Care Seizures 364
15.1. Introduction 364
15.2. Definition 365
15.3. Classification 366
15.4. Incidence and Clinical Presentation 367
15.5. Etiology 369
15.6. Pathophysiology 370
15.7. Differential Diagnosis 373
15.8. EEG 375
15.8.1. Indications and Timing 375
15.8.2. EEG Findings in SE 375
15.8.2.1. Generalized Convulsive SE 375
15.8.2.2. Generalized NCSE or Absence Status 376
15.8.2.3. Complex Partial Status 376
15.8.2.4. Focal Motor Status 376
15.8.2.5. Tonic Status 376
15.8.2.6. Myoclonic Status 376
15.8.2.7. NCSE vs. Metabolic Encephalopathy 377
15.9. Outcome 378
15.10. Goals of ICU Management of Seizures and SE 379
15.10.1. Emergent Medical Management 380
15.10.2. Termination of Seizures and Prevention of Recurrence of Seizures 381
15.10.3. Rationale for Using Specific Anti-Epileptic Medications 383
15.10.4. Medications Used to Control ICU Seizures and SE (Table 15-9) 386
15.10.4.1. Benzodiazepines 386
Introduction 386
Diazepam 386
Lorazepam 387
Midazolam 387
15.10.4.2. Phenytoin and Fosphenytoin 389
15.10.4.3. Valproic Acid (VPA) 390
15.10.4.4. Barbiturates 394
Issues with High Barbiturate Dose Use in the ICU 394
Depth and Duration of Barbiturate Coma 395
Phenobarbital 396
Thiopental 396
Pentobarbital 397
15.10.4.5. Propofol 398
15.10.4.6. Ketamine 399
15.10.4.7. Isoflurane 399
15.10.4.8. Other Less Commonly Used Medications for SE 400
15.10.5. Newer Antiepileptics in the Treatment of Prolonged Seizures or SE (Table 15-11) 401
15.10.5.1. Introduction 401
15.10.5.2. Felbamate 402
15.10.5.3. Gabapentin 402
15.10.5.4. Lamotrigine 402
15.10.5.5. Levetiracetam 403
15.10.5.6. Zonisamide 405
15.10.5.7. Topiramate 405
15.10.5.8. Tiagabine 406
15.10.5.9. Carbamazepine (CBZ) and Oxcarbazepine (OXC) 406
15.10.5.10. Pregabalin 407
15.10.5.11. Lacosamide 407
15.10.6. Hypothermia 408
15.10.7. Resective Surgery 408
15.10.8. Brain Stimulation 409
15.10.9. Prevention and Treatment of Complications 409
15.11. Management of Focal SE 411
15.12. Management of NCSE 412
15.13. Management of Seizures and SE with Antiepileptics in ICU Patients with Organ Dysfunction 414
15.13.1. Hepatic Failure 414
15.13.2. Renal Failure 415
15.13.3. HematoPoetic Dysfunction 416
15.14. Drug Interaction in the ICU 416
References 418
0001096887.pdf 432
| Erscheint lt. Verlag | 24.12.2009 |
|---|---|
| Reihe/Serie | Current Clinical Neurology | Current Clinical Neurology |
| Zusatzinfo | XVI, 432 p. 68 illus., 28 illus. in color. |
| Verlagsort | Totowa |
| Sprache | englisch |
| Themenwelt | Medizin / Pharmazie ► Medizinische Fachgebiete ► Chirurgie |
| Medizin / Pharmazie ► Medizinische Fachgebiete ► Intensivmedizin | |
| Medizin / Pharmazie ► Medizinische Fachgebiete ► Neurologie | |
| Medizin / Pharmazie ► Medizinische Fachgebiete ► Notfallmedizin | |
| Schlagworte | Continuous EEG • Drug-induced seizures • Fulminant Hepatic Failure • Global Hypoxia-Ischemia • Hypertension • Organ Transplant • Seizure Pathophysiology • Status epilepticus • stroke • Trauma • traumatic brain injury |
| ISBN-10 | 1-60327-532-0 / 1603275320 |
| ISBN-13 | 978-1-60327-532-3 / 9781603275323 |
| Haben Sie eine Frage zum Produkt? |
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