Care of the Neurological Patient in the Medical ICU

Abstract

Following a period of dormancy during the 1960s and 1970s, neurological intensive care slowly evolved into its own specialty with the recognition of the unique physiology and sensitivity to injury that affects the central nervous system (CNS) and the realization of the role the CNS plays in critical illness [1,2]. In spite of this, many hospitals do not provide dedicated neurological intensive care and patients are cared for in non-specialized critical care units. Moreover, the outlook for many neurological disorders had previously been one of nihilism. However, fundamental understanding of pathophysiology and translation of research from bench to bedside combined with data from large randomized clinical trials are beginning to turn this nihilistic tide. Therefore, there is a great need to communicate scientific findings in neurological intensive care to the larger critical care community who may not be familiar with this rapidly evolving field. The purpose of this issue is to provide guidance to medical intensivists in the care of several neurological conditions. We review causes and treatments of increased intracerebral pressure and its brain-focused management. The management of blood pressure in critical care neurology especially following cerebro-vascular accidents remains controversial, however recent randomized trial have clarified some of the issues and these are discussed in another article in this review [3].