Care in specialized intensive care units (ICUs) is generally of
higher quality than in general care units. Neurocritical care
focuses on the care of critically ill patients with primary or
secondary neurosurgical and neurological problems and was
initially developed to manage postoperative neurosurgical
patients. It expanded thereafter to the management of patients
with traumatic brain injury (TBI), intracranial hemorrhage and
complications of subarachnoid hemorrhage; including
vasospasm, elevated intracranial pressure (ICP) and the
cardiopulmonary complications of brain injury.
Neurocritical care units have developed to coordinate the
management of critically ill neurological patients in a single
specialized unit, which includes many clinical domains. Care is
provided by a multidisciplinary team trained to recognize and
deal with the unique aspects of the neurological disease
processes, as several treatable neurological disorders are
characterized by imminent risk of severe and irreversible
neurological injury or death if treatment is delayed.
Some diseases need immediate action, so admission to the NICU
is the best solution when there is:
14 | Critical Care in Neurology
1) Impaired level of consciousness.
2) Progressive respiratory impairment or the need for
mechanical ventilation in a neurological patient.
3) Status epilepticus or prolonged seizures.
4) Clinical or Computed Tomographic (CT) evidence of raised
Intracranial Pressure (ICP), whatever the cause (space
occupying lesion, cerebral edema or hemorrhagic
conversion of a cerebral infarct, intracerebral hemorrhage,
etc.)
5) Need for monitoring (for example, level of consciousness,
ICP, continuous electroencephalography (cEEG)), and
6) Need for specific treatments (Baldwin 2010) (e.g.,
neurosurgery, intravenous or arterial thrombolysis).
In the Neurocritical Care unit, patients with primary
neurological diseases such as myasthenia gravis, Guillain-Barré
syndrome, status epilepticus, and stroke have a better outcome
than those patients with secondary neurological diseases. So, we
can conclude that these specialized units have greater
experience in the anticipation, early recognition, and
management of potentially fatal complications.
Early identification of patients at risk of life threatening
neurological illness in order to manage them properly and to
prevent further deterioration is the role of general assessment of
new patients in a neurological emergency. History taking and a
rapid neurological assessment of a specific patient in specialized
neurocritical care units helps answer the question ‘how sick is
this patient?’.
The neurologic screening examination in the emergency
settings focuses primarily on identifying acute, potentially lifethreatening
processes, and secondarily on identifying disorders
that require other opinions, of other specialists.
The importance of urgent neurologic assessment comes from
recent advances in the management of neurologic disorders
needing timely intervention like thrombolysis in acute ischemic
Assessment of Patients in Neurological Emergency | 15
stroke, anticonvulsants for nonconvulsive and subtle generalized
status epilepticus, and plasmapheresis for Guillain-Barré, etc.
It is obvious that interventions can be time-sensitive and can
significantly reduce morbidity and mortality.
A comprehensive neurologic screening assessment can be
accomplished within minutes if performed in an organized and
systematic manner (Goldberg 1987). Neurologic screening
assessment includes six major components of the neurologic
exam, namely:
1) Mental status
2) Cranial nerve exam
3) Motor exam
4) Reflexes
5) Sensory exam
6) Evaluation of coordination and balance.
Based on the chief findings of the screening assessment,
further evaluation or investigations can be then decided upon.
higher quality than in general care units. Neurocritical care
focuses on the care of critically ill patients with primary or
secondary neurosurgical and neurological problems and was
initially developed to manage postoperative neurosurgical
patients. It expanded thereafter to the management of patients
with traumatic brain injury (TBI), intracranial hemorrhage and
complications of subarachnoid hemorrhage; including
vasospasm, elevated intracranial pressure (ICP) and the
cardiopulmonary complications of brain injury.
Neurocritical care units have developed to coordinate the
management of critically ill neurological patients in a single
specialized unit, which includes many clinical domains. Care is
provided by a multidisciplinary team trained to recognize and
deal with the unique aspects of the neurological disease
processes, as several treatable neurological disorders are
characterized by imminent risk of severe and irreversible
neurological injury or death if treatment is delayed.
Some diseases need immediate action, so admission to the NICU
is the best solution when there is:
14 | Critical Care in Neurology
1) Impaired level of consciousness.
2) Progressive respiratory impairment or the need for
mechanical ventilation in a neurological patient.
3) Status epilepticus or prolonged seizures.
4) Clinical or Computed Tomographic (CT) evidence of raised
Intracranial Pressure (ICP), whatever the cause (space
occupying lesion, cerebral edema or hemorrhagic
conversion of a cerebral infarct, intracerebral hemorrhage,
etc.)
5) Need for monitoring (for example, level of consciousness,
ICP, continuous electroencephalography (cEEG)), and
6) Need for specific treatments (Baldwin 2010) (e.g.,
neurosurgery, intravenous or arterial thrombolysis).
In the Neurocritical Care unit, patients with primary
neurological diseases such as myasthenia gravis, Guillain-Barré
syndrome, status epilepticus, and stroke have a better outcome
than those patients with secondary neurological diseases. So, we
can conclude that these specialized units have greater
experience in the anticipation, early recognition, and
management of potentially fatal complications.
Early identification of patients at risk of life threatening
neurological illness in order to manage them properly and to
prevent further deterioration is the role of general assessment of
new patients in a neurological emergency. History taking and a
rapid neurological assessment of a specific patient in specialized
neurocritical care units helps answer the question ‘how sick is
this patient?’.
The neurologic screening examination in the emergency
settings focuses primarily on identifying acute, potentially lifethreatening
processes, and secondarily on identifying disorders
that require other opinions, of other specialists.
The importance of urgent neurologic assessment comes from
recent advances in the management of neurologic disorders
needing timely intervention like thrombolysis in acute ischemic
Assessment of Patients in Neurological Emergency | 15
stroke, anticonvulsants for nonconvulsive and subtle generalized
status epilepticus, and plasmapheresis for Guillain-Barré, etc.
It is obvious that interventions can be time-sensitive and can
significantly reduce morbidity and mortality.
A comprehensive neurologic screening assessment can be
accomplished within minutes if performed in an organized and
systematic manner (Goldberg 1987). Neurologic screening
assessment includes six major components of the neurologic
exam, namely:
1) Mental status
2) Cranial nerve exam
3) Motor exam
4) Reflexes
5) Sensory exam
6) Evaluation of coordination and balance.
Based on the chief findings of the screening assessment,
further evaluation or investigations can be then decided upon.
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