Pub Date : 2019-07-01DOI: 10.1093/med/9780190862923.003.0093
M. Hawkes, E. Wijdicks
Myasthenia gravis (MG) is a well-characterized B-cell–mediated disease caused by autoantibodies against targets located in the postsynaptic end plate of the neuromuscular junction. Fluctuating weakness and fatigability are clinical hallmarks of this disease. MG can be divided into subgroups based on the age at onset, serum antibodies, and thymic tumor, and different clinical courses can be anticipated with each. This chapter describes general concepts about MG, focusing on the triage, work-up, and management of severe myasthenic exacerbation (crisis).
{"title":"Myasthenia Gravis","authors":"M. Hawkes, E. Wijdicks","doi":"10.1093/med/9780190862923.003.0093","DOIUrl":"https://doi.org/10.1093/med/9780190862923.003.0093","url":null,"abstract":"Myasthenia gravis (MG) is a well-characterized B-cell–mediated disease caused by autoantibodies against targets located in the postsynaptic end plate of the neuromuscular junction. Fluctuating weakness and fatigability are clinical hallmarks of this disease. MG can be divided into subgroups based on the age at onset, serum antibodies, and thymic tumor, and different clinical courses can be anticipated with each. This chapter describes general concepts about MG, focusing on the triage, work-up, and management of severe myasthenic exacerbation (crisis).","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"78 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134325510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/med/9780190862923.003.0105
S. Keole
Radiation oncology is the specialty of medicine in which ionizing radiation is used to treat both malignant and benign conditions. The term radiation therapy (RT) is used, in part, as a differentiator from diagnostic radiation. In radiation oncology, treatment is provided with a team-based approach by physicians, nurses, physicists, dosimetrists, and radiation therapists. Dosimetrists perform the initial planning and mapping of the radiation fields. Radiation therapists deliver the treatment with external beam radiation therapy machines.
{"title":"Radiation Therapy","authors":"S. Keole","doi":"10.1093/med/9780190862923.003.0105","DOIUrl":"https://doi.org/10.1093/med/9780190862923.003.0105","url":null,"abstract":"Radiation oncology is the specialty of medicine in which ionizing radiation is used to treat both malignant and benign conditions. The term radiation therapy (RT) is used, in part, as a differentiator from diagnostic radiation. In radiation oncology, treatment is provided with a team-based approach by physicians, nurses, physicists, dosimetrists, and radiation therapists. Dosimetrists perform the initial planning and mapping of the radiation fields. Radiation therapists deliver the treatment with external beam radiation therapy machines.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121465377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/MED/9780190862923.003.0100
A. A. Smith, B. Weinshenker
Patients with central nervous system (CNS) inflammatory demyelinating disease (IDD) usually have acute relapses of neurologic symptoms that frequently remit spontaneously or after corticosteroid administration; they may also present with a progressive neurodegenerative condition, either de novo or after 1 or more acute relapses. Most patients with acute relapses of demyelinating disease do not have severe disability and can be treated as outpatients. Most hospitalizations for patients with multiple sclerosis (MS), for instance, are for reasons unrelated to MS, such as infection. However, patients with CNS IDD occasionally present with serious, emergent complications caused directly by CNS inflammation or indirectly by secondary complications, either of which can require critical care management.
{"title":"Demyelinating Disorders of the Central Nervous System","authors":"A. A. Smith, B. Weinshenker","doi":"10.1093/MED/9780190862923.003.0100","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0100","url":null,"abstract":"Patients with central nervous system (CNS) inflammatory demyelinating disease (IDD) usually have acute relapses of neurologic symptoms that frequently remit spontaneously or after corticosteroid administration; they may also present with a progressive neurodegenerative condition, either de novo or after 1 or more acute relapses. Most patients with acute relapses of demyelinating disease do not have severe disability and can be treated as outpatients. Most hospitalizations for patients with multiple sclerosis (MS), for instance, are for reasons unrelated to MS, such as infection. However, patients with CNS IDD occasionally present with serious, emergent complications caused directly by CNS inflammation or indirectly by secondary complications, either of which can require critical care management.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"174 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115446127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/med/9780190862923.003.0075
Kevin T. Gobeske, E. Wijdicks
Serotonin syndrome affects the central nervous system, the autonomic nervous system, and the neuromuscular system and can have acute and potentially life-threatening manifestations. By definition, serotonin syndrome is associated with changes in serotonin exposure and thus might be described more accurately as serotonergic excess or serotonin toxicity. The central nervous system effects of serotonin involve regulation of attention, arousal, mood, learning, appetite, and temperature.
{"title":"Serotonin Syndrome","authors":"Kevin T. Gobeske, E. Wijdicks","doi":"10.1093/med/9780190862923.003.0075","DOIUrl":"https://doi.org/10.1093/med/9780190862923.003.0075","url":null,"abstract":"Serotonin syndrome affects the central nervous system, the autonomic nervous system, and the neuromuscular system and can have acute and potentially life-threatening manifestations. By definition, serotonin syndrome is associated with changes in serotonin exposure and thus might be described more accurately as serotonergic excess or serotonin toxicity. The central nervous system effects of serotonin involve regulation of attention, arousal, mood, learning, appetite, and temperature.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"76 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129742592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/MED/9780190862923.003.0067
Ayan Sen, Bhavesh M Patel
Mechanical circulatory assist devices (MCADs) are used in patients with decompensated heart failure refractory to medical therapy. The devices are used as a bridge to transplant, as a bridge to recovery for reversible conditions, as a bridge to decision while a patient’s eligibility for transplant is determined, and as destination therapy to support left-sided heart function when a patient is not eligible for transplant. MCADs restore tissue circulation by increasing blood flow and, thereby, improving organ function.
{"title":"Mechanical Circulatory Assist Devices","authors":"Ayan Sen, Bhavesh M Patel","doi":"10.1093/MED/9780190862923.003.0067","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0067","url":null,"abstract":"Mechanical circulatory assist devices (MCADs) are used in patients with decompensated heart failure refractory to medical therapy. The devices are used as a bridge to transplant, as a bridge to recovery for reversible conditions, as a bridge to decision while a patient’s eligibility for transplant is determined, and as destination therapy to support left-sided heart function when a patient is not eligible for transplant. MCADs restore tissue circulation by increasing blood flow and, thereby, improving organ function.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133922738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/med/9780190862923.003.0110
Joseph G. Cernigliaro, D. DiSantis
Hospitalized patients in a critical care environment are at risk for adverse intra-abdominal events involving bowel, solid organs, and vasculature. For assessment of hospitalized patients with abdominal pain, a thorough history and physical examination should precede indicated laboratory testing and imaging studies. One expedient means of evaluation is abdominal radiography. In very ill patients, it can be performed at the bedside. Because of its ready availability and occasional definitive diagnostic information, however, abdominal radiography often is the first imaging study performed. Ideally, a supine frontal image is supplemented with an upright or left lateral decubitus (left-side down) frontal view.
{"title":"Abdominal Radiography","authors":"Joseph G. Cernigliaro, D. DiSantis","doi":"10.1093/med/9780190862923.003.0110","DOIUrl":"https://doi.org/10.1093/med/9780190862923.003.0110","url":null,"abstract":"Hospitalized patients in a critical care environment are at risk for adverse intra-abdominal events involving bowel, solid organs, and vasculature. For assessment of hospitalized patients with abdominal pain, a thorough history and physical examination should precede indicated laboratory testing and imaging studies. One expedient means of evaluation is abdominal radiography. In very ill patients, it can be performed at the bedside. Because of its ready availability and occasional definitive diagnostic information, however, abdominal radiography often is the first imaging study performed. Ideally, a supine frontal image is supplemented with an upright or left lateral decubitus (left-side down) frontal view.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128292778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/med/9780190862923.003.0027
Robert A. Ratzlaff, Jason L. Siegel
Like all forms of shock, cardiogenic shock (CS) is a life-threatening condition of decreased blood circulation that ultimately causes systemic hypoperfusion and end-organ failure. Unlike other forms of shock, however, CS is characterized by failure of the heart itself. This chapter describes CS, including its causes and diagnosis, and provides a brief overview of management.
{"title":"Cardiogenic Shock","authors":"Robert A. Ratzlaff, Jason L. Siegel","doi":"10.1093/med/9780190862923.003.0027","DOIUrl":"https://doi.org/10.1093/med/9780190862923.003.0027","url":null,"abstract":"Like all forms of shock, cardiogenic shock (CS) is a life-threatening condition of decreased blood circulation that ultimately causes systemic hypoperfusion and end-organ failure. Unlike other forms of shock, however, CS is characterized by failure of the heart itself. This chapter describes CS, including its causes and diagnosis, and provides a brief overview of management.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123936483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/MED/9780190862923.003.0086
B. Demaerschalk
Cervical arterial dissections (CDs) are among the most common causes of stroke in young and middle-aged adults. CD is most prevalent in the upper cervical spine and may involve either the vertebral arteries or the carotid arteries. Mechanical forces can lead to intimal injuries of the cervical arteries and result in CD.
{"title":"Cervical Arterial Dissection","authors":"B. Demaerschalk","doi":"10.1093/MED/9780190862923.003.0086","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0086","url":null,"abstract":"Cervical arterial dissections (CDs) are among the most common causes of stroke in young and middle-aged adults. CD is most prevalent in the upper cervical spine and may involve either the vertebral arteries or the carotid arteries. Mechanical forces can lead to intimal injuries of the cervical arteries and result in CD.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130160538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/med/9780190862923.003.0104
Eslam Shosha, Sean J Pittock
Autoimmune encephalitis is an increasingly recognized, life-threatening disorder that, because of its variable clinical presentations, poses a diagnostic challenge in the intensive care setting. Patients with autoimmune encephalitis often need to be in an intensive care unit for management of life-threatening complications commonly related to multifocal nervous system involvement that includes status epilepticus, cognitive decline and behavioral changes, psychosis, and autonomic instability.
{"title":"Autoimmune Encephalitis","authors":"Eslam Shosha, Sean J Pittock","doi":"10.1093/med/9780190862923.003.0104","DOIUrl":"https://doi.org/10.1093/med/9780190862923.003.0104","url":null,"abstract":"Autoimmune encephalitis is an increasingly recognized, life-threatening disorder that, because of its variable clinical presentations, poses a diagnostic challenge in the intensive care setting. Patients with autoimmune encephalitis often need to be in an intensive care unit for management of life-threatening complications commonly related to multifocal nervous system involvement that includes status epilepticus, cognitive decline and behavioral changes, psychosis, and autonomic instability.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"83 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123168512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1093/MED/9780190862923.003.0079
M. Pichler, J. Fugate
Basilar artery occlusion (BAO), a type of posterior circulation stroke, refers to occlusion of the basilar artery at any point along its course. Patients with BAO can present in many ways, depending on the location of the occlusion and the collateral blood supply. Timely recognition of BAO is essential given the potential for effective therapeutic interventions shown to improve outcome.
{"title":"Basilar Artery Occlusion","authors":"M. Pichler, J. Fugate","doi":"10.1093/MED/9780190862923.003.0079","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0079","url":null,"abstract":"\u0000 Basilar artery occlusion (BAO), a type of posterior circulation stroke, refers to occlusion of the basilar artery at any point along its course. Patients with BAO can present in many ways, depending on the location of the occlusion and the collateral blood supply. Timely recognition of BAO is essential given the potential for effective therapeutic interventions shown to improve outcome.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123633873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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