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Neurological emergencies

Classification

Neurological failure can be classified by site into central and peripheral. This affects the way in which patients present to intensive care (Table 1).

 

Central Nervous System

Diminished conscious level

Threatened airway

Absent gag/cough

Failure to maintain normal PaO2 and PaCO2

e.g. Status epilepticus

Peripheral Nervous System

Bulbar symptoms: unable to clear saliva, impaired swallowing

Poor cough

Failure to maintain normal PaCO2 and PaO2

Examples are Guillain Barre syndrome, Myasthenia Gravis, muscular dystrophies

Table 1. Features of central and peripheral neurological failure.

 

General principles

The patient with acute neurological disease should be assessed and treated using the ABCDEF approach as in the Assessment tutorial. You should work through that before carrying on with this tutorial

For the purposes of this tutorial it is a given that appropriate airway, ventilation, cardiovascular assessment, treatment and support are in place.

Any patient presenting with agitation, confusion or reduced conscious level must have a blood sugar measured and hypoglycaemia treated.

Neurological disease may be due primary diseases of the nervous system or a manifestation of systemic disease. It is vital to secure a diagnosis and this requires a systematic approach.

Primary insults causing CNS compromise may involve a number of anatomical and physiological aberrances:

  • Blood and blood vessels: haemorrhage or thrombosis, hypo-perfusion or no perfusion
  • Cerebral tissue: oedema, inflammation, trauma, effects of raised intra-cranial pressure (ICP)
  • CSF: infection, obstruction (hydrocephalus)
  • Electrical activity: seizures, depression eg drugs

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