Principles and Practice of Neurocritical Care

Preface
Acknowledgments
Contents
Part I: History of Neurocritical Care
	1: Introduction to Neurocritical Care
		References
Part II: Basic Principles of Neurocritical Care
	2: Neurological Examination in Neurocritical Care
		2.1	 Introduction
		2.2	 The ABCDE (Airway, Breathing, Circulation, Disability, Exposure) Approach and the ABCGS (Airway, Breathing, Circulation, Glucose, or Seizures) Approach
			2.2.1	 Initial Assessment
			2.2.2	 History and General Examination
			2.2.3	 Neurological Examination of a Conscious Patient
				Neurological Examination of a Patient with an Altered Sensorium
			2.2.4	 Neurological Examination of a Patient in a Coma
		2.3	 Examination of Cranial Nerves (CNs) [5, 11]
			2.3.1	 Motor Functions and Assessment
			2.3.2	 Reflex Examination
				Upper Motor vs. Lower Motor Neuron Disease
			2.3.3	 Motor Examination in an Unconscious Patient
			2.3.4	 Sensory Testing
			2.3.5	 Pupillary Size and Reflex
			2.3.6	 Brainstem Reflexes
			2.3.7	 Neuroexamination in Pediatrics
		References
	3: Cerebrospinal Fluid Dynamics
		3.1	 Introduction
		3.2	 CSF-Containing Spaces [4]
		3.3	 CSF Production
			3.3.1	 From the Choroid Plexus (CP)
				The Role of Ion Channels in CSF Secretion from the CP
				Ion Transport
			3.3.2	 Extra-Choroidal CSF Formation
				Movement of Glucose
				Movement of Proteins
		3.4	 CSF Composition
		3.5	 Continuity between the Ventricular CSF and the Brain ECS
		3.6	 The Role of the Glymphatic System
		3.7	 CSF Flow
		3.8	 CSF Reabsorption
			3.8.1	 Meningeal Lymphatics
			3.8.2	 Continuous Fluid Exchange [13]
		3.9	 CSF Dynamics and ICP Elevation
		3.10	 Hydrocephalus
		3.11	 Idiopathic Intracranial Hypertension (IIH)
		3.12	 Traumatic Brain Injury
		3.13	 Intracerebral Hemorrhage
		3.14	 Subarachnoid Hemorrhage
		3.15	 Ischemic Stroke [13]
		3.16	 Conclusions
		References
	4: Cerebral Hemodynamics
		4.1	 Introduction
			4.1.1	 Special Needs of the Brain
			4.1.2	 Unique Features of Cerebral Circulation
			4.1.3	 Determinants of Cerebral Blood Flow
		4.2	 Regulation of Cerebral Blood Flow
			4.2.1	 Regulation of Cerebral Blood Flow Can Be Divided into Four Categories (Fig. 4.4)
		4.3	 Alterations of Cerebral Blood Flow Regulation in Health and Disease
			4.3.1	 Effect of Aging
			4.3.2	 Effect of Posture
			4.3.3	 Effect of Exercise
			4.3.4	 Effect of Hypertension
			4.3.5	 Effect of Stroke
			4.3.6	 Effect of Anesthesia
		References
Part III: Monitoring in Neurocritical Care
	5: Intracranial Pressure Monitoring
		5.1	 Introduction
		5.2	 ICP Waveform: Physiological and Pathological Trends
		5.3	 Intracranial Pressure–Volume Relationship: Intracranial Compliance
		5.4	 ICP Interplay with Cerebral Perfusion Pressure (CPP)
		5.5	 ICP Measurement
			5.5.1	 Historical Perspective
			5.5.2	 Current Practice
			5.5.3	Invasive ICP Monitoring
			5.5.4	Noninvasive Techniques
		5.6	 Future Avenues for ICP Monitoring
		References
	6: Cerebral Blood Flow Monitoring
		6.1	 Introduction
		6.2	 Arterial Supply of the Brain
		6.3	 The Physiological Aspects of Cerebral Blood Flow
			6.3.1	 Cerebral Physiology and CBF
			6.3.2	 Factors Affecting CBF [9]
				Intrinsic Factors
				Extrinsic Factors Affecting CBF
			6.3.3	 Cerebral Autoregulation (CA)
		6.4	 Cerebral Blood Flow Monitoring
			6.4.1	 General Concepts
				Fick’s Principle
				The Central Volume Principle [37]
				Doppler Effect and Intensity Fluctuations [37]
			6.4.2	 Cerebral Blood Flow Monitoring Techniques
				Direct Techniques
			6.4.3	 Imaging-Based CBF Techniques
				X-Ray-Based Techniques
				MRI-Based Techniques
				Ultrasonography (USG)-Based Techniques
			6.4.4	 Optical Techniques
			6.4.5	 Nuclear Medicine-Based Techniques
			6.4.6	 Monitoring Cerebral Autoregulation
			6.4.7	 Newer Advances
				Microwave-Based CBF Analysis
				Ultrasound-Tagged (UT)-NIRS
		6.5	 Conclusion
		References
	7: Jugular Venous Oximetry
		7.1	 Introduction
		7.2	 History
		7.3	 Relevant Anatomy
		7.4	 Site of Monitoring
		7.5	 Insertion of a Jugular Bulb Catheter
		7.6	 Avoidance of Extracranial Contamination
		7.7	 Intermittent and Continuous Monitoring
		7.8	 Complications
		7.9	 The Fundamental Concepts of Jugular Venous Oximetry
		7.10	 Clinical Applications of SjVO2
			7.10.1	 Traumatic Brain Injury
			7.10.2	 Subarachnoid Hemorrhage
			7.10.3	 Cardiac Surgeries
			7.10.4	 Neuroprognostication after Cardiac Arrest
			7.10.5	 Effect of Anesthetics on SjVO2
		7.11	 Limitations
		7.12	 Conclusions
		References
	8: EEG for the Intensivist: Basics
		8.1	Introduction
		8.2	 Basics of EEG
		8.3	 Important Terminology
		8.4	 Various Patterns Seen in EEG
			8.4.1	 Normal Adult EEG
		8.5	 Pattern 3: Periodic Epileptiform Discharges (PEDs)
			8.5.1	 Periodic Lateralized Epileptiform Discharges or Lateralized Periodic Discharges
			8.5.2	 Bilateral Independent Periodic Lateralized Epileptiform Discharges
			8.5.3	 Generalized Periodic Discharges
			8.5.4	 Stimulus-Induced Periodic, Rhythmic, or Ictal Discharges (SIRPIDs)
			8.5.5	 Triphasic Waves
		8.6	 Pattern 4: Burst-Suppression Pattern (BSP)
		8.7	 Pattern 5: Electrographic Seizures
			8.7.1	 Focal Electrographic Seizures
			8.7.2	 Generalized Electrographic Seizures
		8.8	 Continuous EEG
		References
	9: Transcranial Doppler
		9.1	 Introduction
		9.2	 Physical Principle
		9.3	 Transcranial Doppler (TCD) Versus Transcranial Color-Coded Duplex Sonography (TCCD)
		9.4	 Technique of TCD
		9.5	 Spectral Waveform Analysis
		9.6	 TCD Indices
		9.7	 Assessment of Cerebral Hemodynamics by TCD
		9.8	 Clinical Uses
		9.9	 Limitations of TCD
		9.10	 Summary
		References
	10: Evoked Response Monitoring
		10.1	 Introduction
		10.2	 Applied Anatomy
		10.3	 Basics of Recording
			10.3.1	 Montages
			10.3.2	 Nearfield and Far-Field Potentials [3, 5]
			10.3.3	 Nomenclature, Amplitude, and Latency
		10.4	 Recording Technique
			10.4.1	 Upper Limb
			10.4.2	 Lower Limb
		10.5	 Interpretation
		10.6	 Prolongation of Latency
		10.7	 Changes in Amplitude
		10.8	 Absence of Waves
			10.8.1	 Upper Limb (Table 10.3)
			10.8.2	 Lower Limb (Table 10.4)
		10.9	 Factors Affecting SSEPs
		10.10	 Indications and Common Applications in Critical Care
			10.10.1	 Prognostication After Cardiac Arrest [12–18]
			10.10.2	 Prognostication After Traumatic Brain Injury [1, 19–21]
		10.11	 Other Uses
		10.12	 Multimodal Monitoring [23, 24]
		10.13	 Other Evoked Responses in Critical Care [25]
		References
	11: Near Infrared Spectroscopy
		11.1	 Introduction
		11.2	 Factors Affecting NIRS-Based Cerebral Oximetry Readings
		11.3	 Clinical Application of NIRS-Based Cerebral Oximetry in NICU
		References
	12: Brain Tissue Oxygenation
		12.1	 Introduction: The Physiology of Brain Oxygen
			12.1.1	 Systemic Determinants of Brain Oxygen
			12.1.2	 Arterial Oxygen Content
			12.1.3	 Cerebral Blood Flow
			12.1.4	 Capillary Oxygen Delivery
			12.1.5	 Oxygen Diffusion
		12.2	 Brain Tissue Oxygen Monitoring
			12.2.1	 Normal Values for Brain Oxygen Levels
		12.3	 Methodological Issues with Clinical Monitoring of pbtO2
			12.3.1	 Systemic Determinants of PbtO2
			12.3.2	 The Balance of Supply and Demand
			12.3.3	 Local Tissue Factors Influencing PbtO2 Readings
		12.4	 Brain Tissue Oxygen Monitoring in TBI
			12.4.1	 Ischemia as a Component of Secondary Brain Injury in TBI
			12.4.2	 Mechanisms of Brain Hypoxia and Dysoxia
			12.4.3	 Identification of Brain Hypoxia with PbtO2
			12.4.4	 Outcomes Associated with Low PbtO2
			12.4.5	 Protocolized Approach to Brain Hypoxia
			12.4.6	 Randomized Trials of PbtO2-Based Management in TBI
		12.5	 Brain Tissue Oxygen Monitoring in SAH
			12.5.1	 Mechanisms of Brain Injury in SAH
		12.6	 PbtO2 Monitoring in SAH
			12.6.1	 Evidence for PbtO2 Use in SAH
		12.7	 The Future of Brain Oxygen Monitoring in Acute Brain Injury
			12.7.1	 Indices of Auto-regulation
			12.7.2	 Use of PbtO2 Monitoring in CSD
		12.8	 Conclusions
		References
	13: Brain Microdialysis
		13.1	 Introduction
		13.2	 The Principle of Microdialysis
		13.3	 Factors Affecting Solute Recovery
			13.3.1	 Flow Rate of Perfusate
			13.3.2	 Characteristics of Semipermeable Membrane
			13.3.3	 Characteristics of Analyte
			13.3.4	 Temperature
			13.3.5	 Tissue Factors
		13.4	 Clinical Applications of Microdialysis in Brain Injury
			13.4.1	 Aneurysmal Subarachnoid Hemorrhage
			13.4.2	 Traumatic Brain Injury
			13.4.3	 Acute Ischemic Stroke
			13.4.4	 Brain Tumor
			13.4.5	 Epilepsy
		13.5	 Other Applications of Cerebral Microdialysis
		13.6	 Future Applications
		References
	14: Neuroimaging: CT Scan and MRI
		14.1	 Introduction
		14.2	 Imaging Modalities
			14.2.1	 Computed Tomography
			14.2.2	 Magnetic Resonance Imaging
			14.2.3	 Basic Sequences of MRI
			14.2.4	 Digital Subtraction Angiography
		14.3	 Different Spectrum of Pathology
		14.4	 Summary
		References
	15: Brain Ultrasonography
		15.1	 Introduction
		15.2	 Principles of Brain Ultrasound
		15.3	 Clinical Applications
			15.3.1	 Midline Shift
			15.3.2	 Intraparenchymal Hemorrhage
			15.3.3	 Extra-axial Hemorrhage
			15.3.4	 Hydrocephalus
			15.3.5	 Post-surgical Applications
			15.3.6	 Limitations of Brain Ultrasound
			15.3.7	 Orbital Ultrasound
			15.3.8	 Optic Nerve Sheath Diameter
			15.3.9	 Papilledema
			15.3.10 Eye Movements and Pupillary Light Reflex
		15.4	 Conclusions
		References
Part IV: Neuropharmacology in Neurocritical Care
	16: Sedation and Analgesia
		16.1	 Introduction
		16.2	 Indications
			16.2.1	 General Indication
			16.2.2	 Brain-Specific Indications
		16.3	 Selection of Sedatives and Analgesics in the NCCU [6, 10, 11]
		16.4	 Assessing Patients While on Sedation in the NCCU
		16.5	 Monitoring of Sedation and Analgesia in the NCCU
		16.6	 A Practical Approach for the Use of Sedation and Analgesia in the NCCU
		16.7	 Withdrawal of Sedation in NCCU Patients
		16.8	 Conclusion
		References
	17: Antiseizure Medications
		17.1	 Introduction
		17.2	 Seizure Prophylaxis
		17.3	 Acute Treatment of Seizures
			17.3.1	 Benzodiazepines
			17.3.2	 Antiseizure Medications
				First-Generation Antiseizure Medications
				Second-Generation Antiseizure Medications
				Third-Generation Antiseizure Medications
		17.4	 Treatment of Medical Emergencies with Antiseizure Medications (ASMs)
			17.4.1	 Emergent Therapy for Status Epilepticus
			17.4.2	 Urgent Therapy for Status Epilepticus
			17.4.3	 Refractory Status Epilepticus Treatment
				Anesthesia Weaning
			17.4.4	 Super-Refractory Status Epilepticus
		17.5	 ICU Interventions Which Impact Pharmacotherapy
			17.5.1	 Renal Replacement Therapy
			17.5.2	 Plasmapheresis
			17.5.3	 Therapeutic Hypothermia
		17.6	 Summary
		References
	18: Antibiotic Drugs
		18.1	 Introduction
		18.2	 Pharmacokinetics (PK) and Pharmacodynamics (PD)
			18.2.1	 PK–PD Parameters of the Major Classes of Antimicrobials
			18.2.2	 Alterations in the PK Parameters in ICU Patients
		18.3	 PK–PD Parameters of the Major Classes of Antimicrobials
			18.3.1	 Beta-lactams
			18.3.2	 Linezolid
			18.3.3	 Vancomycin
		18.4	 Antibiotic Prophylaxis for Neurosurgical Patients
		18.5	 Principles of Surgical Prophylaxis
		18.6	 Antimicrobial Therapy for Community Acquired Meningitis
			18.6.1	 Repeat Lumbar Puncture
			18.6.2	 Duration of Therapy
		18.7	 Healthcare-Associated Meningitis
		18.8	 Antimicrobial Considerations
		18.9	 Management of Healthcare-Associated Meningitis/Ventriculitis
		18.10	 Shunt and Reservoir Infections
			18.10.1 Shunt Reimplantation
		18.11	 Intrathecal/Intraventricular Antibiotics
			18.11.1 Factors Affecting CSF Concentration
			18.11.2 Infectious Disease Society of America (IDSA) Recommendations Includes
			18.11.3 Adjunctive Therapy Along with Intrathecal Administration
		18.12	 Drug to Drug Interactions (DDI)
			18.12.1 Pharmacokinetics (PK) and Pharmacodynamics (PD) in Drug–Drug Interaction
			18.12.2 Carbapenems
			18.12.3 Erythromycin
			18.12.4 Linezolid
			18.12.5 AAE (Antibiotic-Associated Encephalopathy)
		18.13	 Conclusion
		References
	19: Antiviral Drugs
		19.1	 Introduction
		19.2	 Viruses Causing Encephalitis/Myelitis
		19.3	 Antivirals Practiced in Encephalitis
			19.3.1	 Acyclovir and Valacyclovir
			19.3.2	 Ganciclovir and Valganciclovir
			19.3.3	 Foscarnet
			19.3.4	 Cidofovir
			19.3.5	 Leteromovir
		19.4	 HIV and Antiretroviral Drugs
			19.4.1	 HIV Encephalitis
				Diagnosis
				Management
					HIV-Associated CD8 Encephalitis
			19.4.2	 Opportunistic Infections
			19.4.3	 IRIS
			19.4.4	 Antiretroviral Drugs Related Neuropsychiatric Complications
		19.5	 Antiretroviral Drugs
			19.5.1	 Nucleoside Reverse Transcriptase Inhibitor
			19.5.2	 Nonnucleoside Reverse Transcriptase Inhibitors
			19.5.3	 Protease Inhibitors
			19.5.4	 Integrase Inhibitors
			19.5.5	 Entry and Fusion Inhibitors
		19.6	 Neuropsychiatry Effects of Other Antivirals
			19.6.1	 Antiviral Drugs in Influenza
			19.6.2	 Antivirals in Chronic Hepatitis B
			19.6.3	 Antivirals in Hepatitis C
		19.7	 Newer/Investigational Antivirals
			19.7.1	 Brincidofovir
			19.7.2	 Maribavir
			19.7.3	 Pritelivir
		19.8	 Conclusion
		References
	20: Antifungal Drugs
		20.1	 Introduction and Epidemiology
		20.2	 Classification of Fungi
		20.3	 Classification of Antifungal Agents
		20.4	 Mechanism of Action
		20.5	 Drug Toxicities
			20.5.1	 Polyenes
			20.5.2	 Azoles
		20.6	 Recommendations of Recent Guidelines
			20.6.1	 Regarding Invasive Candidiasis
			20.6.2	 For Invasive Aspergillosis
		20.7	 Conclusion
		References
	21: Antihypertensive Therapy
		21.1	 Introduction
		21.2	 Definitions of Hypertension
			21.2.1	 Causes of Hypertension
			21.2.2	 Blood Pressure Goals in Neurocritical Care
			21.2.3	 Pharmacology of Antihypertensive Drugs
			21.2.4	 RAS Inhibitors
			21.2.5	 Angiotensin-Converting Enzyme (ACE) Inhibitors
			21.2.6	 Angiotensin Receptor Blocker (ARB) Drugs
			21.2.7	 Direct Renin Inhibitors
		21.3	 Adrenoceptor Antagonists
			21.3.1	 Beta-Blockers (BBs)
			21.3.2	 Alpha-Blockers
			21.3.3	 Calcium Channel Blockers (CCBs)
			21.3.4	 Diuretics
			21.3.5	 Vasodilators
			21.3.6	 Centrally Acting Agents
		21.4	 Conclusions
		References
	22: Hypoglycaemic Drugs
		22.1	 Introduction
		22.2	 Classification of Hypoglycaemic Drugs
		22.3	 Insulin
			22.3.1	 Chemistry
			22.3.2	 Mechanism of Action
			22.3.3	 Types of Insulin
				Rapid-Acting Insulins
				Short-Acting Insulin
				Intermediate-Acting Insulins
				Long-Acting Insulins
				Ultra-Long Acting Insulin
			22.3.4	 Insulin Strengths
			22.3.5	 Insulin Administration
			22.3.6	 Insulin Delivery Devices
			22.3.7	 Monitoring During Insulin Therapy
			22.3.8	 Adverse Effects of Insulin
			22.3.9	 Literature Support for Insulin Use in ICU Patients
		22.4	 Hypoglycaemic Agents for Type 2 DM
			22.4.1	 Introduction
			22.4.2	 Mechanism of Action
			22.4.3	 Types
		22.5	 Parenteral Hypoglycaemic Agents
		22.6	 Advantages and Disadvantages of Hypoglycemics
		22.7	 Clinical Implications in Neurocritical Care
		22.8	 Future Prospects
		22.9	 Conclusions
		References
	23: Vasopressor Drugs
		23.1	 Introduction
		23.2	 Function of Adrenergic and Dopaminergic Receptors
			23.2.1	 Norepinephrine (Noradrenaline)
			23.2.2	 Epinephrine (Adrenaline)
			23.2.3	 Dobutamine
			23.2.4	 Vasopressin
		23.3	 Exogenous Vasopressors and Inotropes
			23.3.1	 Dopexamine
		23.4	 Sympathomimetics
			23.4.1	 Ephedrine
			23.4.2	 Phenylephrine
			23.4.3	 Angiotensin II
		23.5	 Role of Vasopressors in Neurological Conditions
			23.5.1	 Subarachnoid Hemorrhage
			23.5.2	 Traumatic Brain Injury (TBI)
			23.5.3	 Spinal Cord Injury
			23.5.4	 Vasopressors in Acute Ischemic Stroke
		23.6	 Sepsis and the Brain
		23.7	 Conclusion
		References
	24: Steroids
		24.1	 Introduction
		24.2	 Fundamental Concepts Regarding CS Therapy in NICU
		24.3	 Synthetic CSs
		24.4	 CSs in Critical Neurological/Neurosurgical Disorders
			24.4.1	 Brain Neoplasms
			24.4.2	 CNS Infections
				Bacterial Meningitis (BM)
				Tubercular Meningitis (TBM)
				Tuberculomas, Spinal Cord Tuberculosis
				Brain Abscess
				Herpes Simplex Encephalitis (HSVE)
				Neurocysticercosis (NCC)
				Cerebral Toxoplasmosis, Neurolisteriosis, Cryptococcal Meningitis (CM)
				Immune Reconstitution Syndrome (IRIS)
			24.4.3	 Autoimmune Neurological Disorders
				MS
				MG
				SRE
			24.4.4	 CNS Trauma
				SCI
		24.5	 CS in Critical Non-Neurological Illnesses
			24.5.1	 CIRCI: Septic Shock, ARDS
			24.5.2	 Endocrine Failure
			24.5.3	 Airway Crisies, Obstructive Airway Disease, Anaphylaxis, Graft Donor Management
		24.6	 NICU Disorders in Which CSs Are Not Indicated
			24.6.1	 TBI
			24.6.2	 Acute Ischemic Stroke (AIS), ICH, Aneurysmal Subarachnoid Hemorrhage (aSAH), Guillian Barre Syndrome (GBS)
		24.7	 Role of Mineralocorticoids in the NICU
		24.8	 Conclusions
		References
	25: Antipsychotic Drugs
		25.1	Introduction
		25.2	 Classification
		25.3	 Mechanism of Action
			25.3.1	 Indication [13–20]
			25.3.2	 Side Effects
			25.3.3	 Contraindications
				Anti-Psychotics Related Problems in ICU
		25.4	 Neuroleptic Malignant Syndrome
		25.5	 Conclusion
		References
	26: Anticoagulants Antiplatelets and Antifibrinolytics
		26.1	 Introduction
		26.2	 Physiology of Hemostasis
		26.3	 Anticoagulants
			26.3.1	 Unfractionated Heparin (UFH)
				Mechanism of Action
				Route of Administration
				Pharmacologic Properties
				Adverse Effects
				Monitoring Test
				Neurocritical Care Indications
				Contraindications
				Interactions
				Reversal Agent
			26.3.2	 Low-Molecular-Weight Heparins (LMWH)
				Mechanism of Action
				Route of Administration
				Therapeutic Dose
				Pharmacologic Properties
				Reversal Agent
				Monitoring Test
			26.3.3	 Fondaparinaux
			26.3.4	 Warfarin
				Mechanism of Action
				Route of Administration
				Pharmacologic Properties
				Dosing and Administration
				Monitoring Test
				Adverse Effects
				Indications of Warfarin in Neurocritical Care Setting
			26.3.5	 Novel Oral Anticoagulants (NOAC)
				Dabigatran Etexilate
					Pharmacologic Properties
					Dose
					Contraindications
					Adverse Effects
					Reversal
				Rivaroxaban
					Pharmacologic Properties
					Dose
					Contraindications
					Reversal
				Apixaban
					Pharmacologic Properties
					Interactions
					Side Effects
					Antidote
		26.4	 Antifibrinolytics
			26.4.1	 Aprotinin
				Mechanism of Action
				Dose and Route of Administration
				Pharmacokinetics
				Clinical Indications
				Adverse Effects
				Precautions
			26.4.2	 Tranexamic Acid
				Mechanism of Action
				Dose and Route of Administration
				Pharmacokinetics
				Clinical Indications
				Adverse Effects
				Precautions
				Contraindications
			26.4.3	 Epsilon Amino Caproic Acid
				Dose and Route of Administration
				Pharmacokinetics
				Side Effects
			26.4.4	 Monitoring Antifibrinolytics
			26.4.5	 Antifibrinolytics in Neurocritical Care
				Traumatic Brain Injury
				Spontaneous Intracranial Hemorrhage (ICH)
				Aneurysmal Subarachnoid Hemorrhage (SAH)
		26.5	 Antiplatelet Agents
			26.5.1	 Role of Platelets
			26.5.2	 Aspirin
				Chemical Properties
				Mechanism of Action
				Dose and Route of Administration
				Pharmacokinetics
				Pharmacodynamics
				Indications
				Side Effects
				Precautions
			26.5.3	 Clopidogrel
				Mechanism of Action
				Dose and Route of Administration
				Pharmacokinetics
				Clinical Indications
				Side Effects and Contraindications
				Drug Interactions and Precautions
			26.5.4	 Prasugrel
				Mechanism of Action
				Pharmacokinetics
				Uses
				Adverse Effects
				Contraindications
		26.6	 ADP Receptor Antagonists
			26.6.1	 Ticagrelor
				Mechanism of Action
				Dose and Route of Administration
				Pharmacokinetics
				Indications
				Contraindications
				Side Effects
				Drug Interactions
			26.6.2	 Cangrelor
				Mechanism of Action
				Dose
				Pharmacokinetics
				Pharmacodynamics
				Side Effects
		26.7	 Phosphodiesterase Inhibitors
			26.7.1	 Dipyridamole
				Mechanism of Action
				Dose
				Pharmacokinetics
				Side Effects
			26.7.2	 Cilostazol
				Dose and Route of Administration
				Pharmacokinetics
				Pharmacodynamics
				Indications
				Adverse Effects
		26.8	 Glycoprotein (GP) IIb/IIIa Inhibitors
			26.8.1	 Abciximab
				Mechanism of Action
				Dose and Route
				Pharmacokinetics
				Clinical Indications
				Contraindications
				Side Effects
				Monitoring
				Management of Toxicity
			26.8.2	 Eptifibatide
				Mechanism of Action
				Dose and Route of Administration
				Pharmacokinetics
				Indications
				Adverse Effects
				Contraindications
			26.8.3	 Tirofiban
				Mechanism of Action
				Dose
				Pharmacokinetics
			26.8.4	 Monitoring Antiplatelet Agents
			26.8.5	 Antiplatelets in Neurocritical Care
				Stroke
				Spontaneous Intracerebral Hemorrhage
				Subarachnoid Hemorrhage
				Periprocedural Antiplatelets in Neuroendovascular Interventions
			26.8.6	 Resistance to Antiplatelet Therapy
		26.9	 Summary
		26.10	 Conclusion
		References
	27: Osmotherapy
		27.1	 Introduction
		27.2	 Principles Behind the Use of Osmotherapy
		27.3	 What Are the Options?
			27.3.1	 Pharmacology of the Agents
				Mannitol
				Hypertonic Saline
				Sodium Bicarbonate
				Hypertonic Sodium Lactate
				Glycerol
		27.4	 Practical Pearls
			27.4.1	 Indications
				Evidence in Different Pathologies
			27.4.2	 Routes of Administration (Peripheral vs Central)
			27.4.3	 Combination of Therapy (Mannitol and HTS)
			27.4.4	 How Long to Be Given
			27.4.5	 Hyperosmolar Agents and Acute Kidney Injury
		27.5	 Conclusion
		References
Part V: Systemic Neurocritical Care
	28: Cardiac Problems in  Neurocritical Care
		28.1	 Introduction
		28.2	 Pathophysiology of Cardiac Injury in Brain Injury
			28.2.1	 Neurogenic Stunned Myocardium (NSM)
			28.2.2	 Stress Cardiomyopathy
			28.2.3	 Neurogenic Pulmonary Edema (NPE)
		28.3	 Cardiac Complications in Traumatic Brain Injury (TBI)
			28.3.1	 Cardiac Complications in Acute Ischemic Stroke (AIS)
			28.3.2	 Cardiac Complications in Subarachnoid Hemorrhage (SAH)
			28.3.3	 Cardiac Complications in Intracerebral Hemorrhage (ICH)
		28.4	 Cardiac Complications in Spinal Cord Injury
		28.5	 Cardiac Complications in Potential Brain Death Organ Donors
		28.6	 Cardiac Complications in Epilepsy
		28.7	 Cardiac Dysfunction in Guillain Barre Syndrome (GBS)
		28.8	 Cardiac Complications in Myasthenia Gravis (MG)
		28.9	 Cardiac Issues in Neuromuscular Disorders (NMD)
		28.10	 Management of Cardiac Complications in Neurocritical Care
		References
	29: Respiratory Problems in Neurocritical Care
		29.1	Introduction
		29.2	Neurological Diseases
		29.3	Neurosurgical Procedures
		29.4	Neurotrauma
		29.5	Brain–lung Cross Talk
		References
	30: Renal Problems in Neurocritical Care
		30.1	 Introduction
		30.2	 Defining Acute Kidney Injury
		30.3	 Burden of AKI in Neurocritically Ill Patients
		30.4	 Pathophysiology of AKI in Neurocritically Ill Patients
			30.4.1	 Brain–Kidney Organ Crosstalk
			30.4.2	 Osmo-Diuretics in AKI
			30.4.3	 Loop Diuretics in AKI
			30.4.4	 Vasopressors in AKI
		30.5	 Diagnosis of AKI IN Neurocritically Ill Patients
			30.5.1	 History and Clinical Evaluation
			30.5.2	 Diagnostic Testing
				Functional Biomarkers
				Damage and Stress Biomarkers
				Additional Tests
		30.6	 Management of AKI in Neurocritically Ill Patients
			30.6.1	 AKI Risk-Prediction
			30.6.2	 Minimizing Secondary Injury
			30.6.3	 Management Strategies
				Hemodynamic Management
				Nephrotoxic Drug Management
				Ventilatory Management
				Anemia Management
				Glycemic Control
				Nutritional Support
		30.7	 Contrast-Induced Acute Kidney Injury
			30.7.1	 Incidence in Neurocritically Ill
			30.7.2	 Pathogenesis
			30.7.3	 Periprocedural Management
		30.8	 Gadolinium-Based Contrast Agents and Nephrotoxicity
		30.9	 Renal Replacement Therapies in Neurocritically Ill Patients
			30.9.1	 Techniques
			30.9.2	 Mechanism of Worsening Cerebral Edema
			30.9.3	 Timing of Initiation of RRT
			30.9.4	 Treatment Modifications in Neurocritically Ill
		30.10	 Future Directives
		References
	31: Endocrine Dysfunction in Acute Brain Injury
		31.1	 Introduction
		31.2	 Physiology of the  Brain–Endocrine Axis
		31.3	 Endocrine Dysfunction in Traumatic Brain Injury
		31.4	 Endocrine Dysfunction Following Acute Stroke
		31.5	 Endocrine Dysfunction in Aneurysmal SAH
		31.6	 Summary
		Appendix
		References
	32: Myopathies in Neurocritical Care
		32.1	 Introduction
		32.2	 Epidemiology and Risk Factors
		32.3	 Pathophysiology
			32.3.1	 Functional Aberrations in the Involved Muscle
		32.4	 Classification of ICUAW
		32.5	 Clinical Presentation
		32.6	 Evaluation and Diagnosis
			32.6.1	 Functional Assessment
				Volitional Functional Testing for Peripheral Muscle Assessment
				Volitional Functional Testing for Respiratory Muscles
				Non-Volitional Functional Testing for Respiratory Muscles
			32.6.2	 Imaging
		32.7	 Diagnostic Criteria for ICUAW Based on Electrodiagnostic Testing [43]
		32.8	 Preventive and Therapeutic Interventions for ICUAW
			32.8.1	 Role of Pharmacological Interventions
			32.8.2	 Role of Physiotherapy in ICUAW
				Respiratory Muscle Training
				Physical Training
			32.8.3	 Prognosis
			32.8.4	 Complications
		32.9	 Management
			32.9.1	 Rehabilitation During the ICU Stay
			32.9.2	 Barriers to Successful Mobilization
			32.9.3	 Safety Concerns During Mobilization
			32.9.4	 Newer Horizons in Rehabilitation
			32.9.5	 Rehabilitation and Care after ICU Discharge
		32.10	 Summary and Conclusion
		References
	33: Gastrointestinal Problems in Neurocritical Care
		33.1	Introduction
		33.2	 Erosive Gastritis and Duodenitis
		33.3	 Increased Intestinal Permeability and Bacterial Translocation
		33.4	 Gastrointestinal Motility Disorders
		33.5	 Systemic Immune Reactions in Lesions of the Gastrointestinal System
		33.6	 Microbiota Disorder
		33.7	 Antibiotic-Associated Diarrhea
		References
	34: Role of Clinical Neuropsychology
		34.1	Introduction
		34.2	 What
		34.3	 Why
		34.4	 How
		34.5	 Three Stages of Neuropsychological Psycho-diagnostics
			34.5.1	 Clinical Interview
			34.5.2	 Psychometric Testing
			34.5.3	 Cognitive Rehabilitation and Interventions
		34.6	 Whom
		34.7	 Conclusion
		References
Part VI: Supportive Neurocritical Care
	35: Mechanical Ventilation in Traumatic/Acute Brain Injury
		35.1	 Introduction
		35.2	 Epidemiology and Risk Factors of ARDS in Acute Brain Injury
			35.2.1	 Milestone of MV in Neurologically Diseased Patients
		35.3	 Pathophysiology of Lung Injury in Acute Brain Injury: Brain Lung Cross Talk
		35.4	 Ventilatory Strategies
		35.5	 Putting It All Together from Intubation to Extubation and Finally Indications for Tracheostomy [2]
		35.6	 Conclusion
		References
	36: Fluid Management in Neurocritical Care
		36.1	 Introduction
		36.2	 Pathophysiology
			36.2.1	 Tonicity of Administered Fluids
			36.2.2	 Cerebral Edema
			36.2.3	 Autoregulation
		36.3	 Fluid Management in NCC: Quantity of Maintenance Fluids: How Much to Give?
		36.4	 Type of Maintenance Fluids: Which Fluids to Give?
		36.5	 Fluid Administration Based on Assessment of Circulation
		36.6	 Conclusions
		References
	37: Nutrition in Neurocritical Care
		37.1	 Introduction
		37.2	 Nutritional Assessment in Patients Admitted to Neurocritical ICUs
		37.3	 Estimation of Nutritional Requirements
		37.4	 Initiation and Monitoring of Nutrition
		37.5	 Special Nutritional Considerations in NCC
		37.6	 Conclusions
		References
	38: Fever in Neurocritical Care
		38.1	 Introduction
		38.2	 What Is Fever? Why Is It Harmful for Neurological Disease-Affected Patients?
		38.3	 Why Treat a Fever?
		38.4	 Pathophysiology of Fever in Neuro ICU
		38.5	 Manifestations of Fever on the Brain
		38.6	 Causes of Fever in Neuro ICU
			38.6.1	 Infectious
			38.6.2	 Non-infectious
			38.6.3	 Hyperthermia Syndromes in Neuro-intensive Care
		38.7	 Investigations and Treatment
		38.8	 Conclusion
		References
	39: Sepsis in Neurocritical Care
		39.1	 Introduction
		39.2	 Definitions
		39.3	 Primary Brain Injury and Secondary Sepsis
		39.4	 Primary Sepsis and Secondary Brain Injury
		39.5	 Conclusions
		References
	40: Cerebral Resuscitation in Neurocritical Care
		40.1	Introduction
		40.2	 Optimizing Perfusion Pressures
			40.2.1	 Ischemic Stroke
			40.2.2	 Hemorrhagic Stroke
			40.2.3	 Traumatic Brain Injury
			40.2.4	 Sepsis and Septic Shock
			40.2.5	 Promoting Macrocirculation
		40.3	 Optimizing Brain Volume
			40.3.1	 Nonpharmacological Management
				Surgical Decompression
		40.4	 Optimizing Glycemic Control
			40.4.1	 Optimizing Oxygenation and Ventilation
			40.4.2	 Control of Fever
			40.4.3	 Optimizing Nutrition
			40.4.4	 Analgosedation
			40.4.5	 Optimizing Hemoglobin
			40.4.6	 Electrolyte Abnormalities
			40.4.7	 Seizure Control
		40.5	 Conclusion
		References
	41: Coma in Neurocritical Care
		41.1	 Introduction
		41.2	 Consciousness Level and Content
		41.3	 Pathophysiological Basis of Disorders of Consciousness
		41.4	 Causes of DoC at Emergency Department
		41.5	 Neurologic Complications of Critical Medical Illnesses
		41.6	 Diagnostic Step at Emergency Department
		41.7	 Determination of the Depth of the DoC
		41.8	 Non-convulsive Status Epilepticus (NCSE)
		41.9	 Diagnostic Bedside Tools and Devices in the Critically Ill Update
		41.10	 Therapeutic Interventions in Prolonged DoC
		41.11	 Personal View on the Therapeutic Interventions for Refractory Prolonged DoC
		41.12	 Curing Coma Campaign
		References
	42: Physiotherapeutic Management in Neurocritical Care
		42.1	Introduction
		42.2	 Physiotherapy in Respiratory Impairments
			42.2.1	 Chest Physiotherapy
			42.2.2	 Techniques of Chest Physiotherapy
				Therapeutic Body Positioning
				Percussion
				Vibrations
			42.2.3	 Manual Hyperinflation
			42.2.4	 Active Cycle of Breathing Technique (ACBT)
			42.2.5	 Autogenic Drainage (AD)
			42.2.6	 Positive Airway Pressure Techniques
			42.2.7	 Respiratory Muscle Training
		42.3	 Prevention and Management of ICUAW
		42.4	 Prevention and Management of Deep Vein Thrombosis
		42.5	 Physiotherapy Management of Altered State of Consciousness
			42.5.1	 Brain-Computer Interface (BCI)
		42.6	 Management of Spasticity, Muscle Tightness, and Contractures
		42.7	 Conclusion
		References
	43: Palliative Care in Neurocritical Care
		43.1	 Introduction
		43.2	 Palliative Care in Neuro-critical Care: Is There a Need?
			43.2.1	 Issues of Palliative Care in Neuro-intensive Care
			43.2.2	 Unique Issues for Palliative Care in Neuro-intensive Care Unit: [6] See Table 43.2
		43.3	 WHO Should Be Offered Palliative Care in Neuro-intensive Care
			43.3.1	 Advanced Directive [14, 15]
		43.4	 Palliative Care Plan: How to Communicate?
		43.5	 Treatment Domains of Palliative Care in Neuro-ICU (See Fig. 43.2)
		43.6	 Strategies to Help Ensure the Delivery of Appropriate and Optimal Patient-Centered Care for Patients at High Risk of Death or Severe Disability [23] (See Fig. 43.3)
			43.6.1	 Barriers of Palliative Care
			43.6.2	 Precision Palliative Care Plan
		43.7	 Conclusion
		References
	44: Neurocritical Care Nursing
		44.1	 Introduction
		44.2	 Neuro-critical Care Nurse
		44.3	 Features of Neuro-critical Care Nursing
		44.4	 Familiarity with Neuro-disease Processes and Diagnostics
		44.5	 Communication
		44.6	 Teamwork, Confidence and Attitude
		44.7	 Attention to Detail
		44.8	 Decision-Making
		44.9	 Focus and Dedication
		44.10	 Technical Proficiency
		44.11	 Compassion and Patience
		44.12	 Reporting/Handover
			44.12.1 Assessment
			44.12.2 Codes
			44.12.3 Physicians Round
			44.12.4 Nursing Care
			44.12.5 Documentation
			44.12.6 Furthering the Care Plan: Working Towards a Transfer
			44.12.7 Patient Flow
			44.12.8 Dealing with Death
			44.12.9 Finishing Up
		44.13	 Conclusion
		References
Part VII: Case-Based Neurocritical Care
	45: Traumatic Brain Injury and Neurocritical Care
		Case
		45.1	 Introduction
		45.2	 Classification of TBI
		45.3	 Pathophysiology of TBI
			45.3.1	 Primary Traumatic Brain Damage
			45.3.2	 Secondary Brain Damage
				Cellular Metabolism and Cell Death
				Cerebral Blood Flow
				Cerebral Autoregulation and Carbon Dioxide (CO2) Reactivity
				Post-Traumatic Vasospasm
				Cerebral Oxygenation
				Edema
				Inflammation and Cell Death
		45.4	 Monitoring of Brain Trauma Patient
			45.4.1	 Intracranial Pressure Monitoring
			45.4.2	 Brain Oxygen Tension (PtiO2)
			45.4.3	 Transcranial Doppler (TCD)
			45.4.4	 Cerebral Microdialysis (MD)
			45.4.5	 Continuous Electroencephalography (cEEG)
		45.5	 Principles of Management of Head Injured Patient
			45.5.1	 Management of Mild TBI (GCS 13–15)
			45.5.2	 Prehospital Care for Moderate to Severe Head Injury
			45.5.3	 Hospital Care
		45.6	 Outcomes
		References
	46: Epilepsy and Neurocritical Care
		46.1	 Introduction
		46.2	 Epileptic Seizures in Neurocritical Care Unit
		46.3	 Recognizing Seizures in Neurocritical Care Unit
			46.3.1	 Clinical Presentation
			46.3.2	 Continuous Electroencephalography Monitoring
		46.4	 Seizure Prophylaxis in Neurocritical Care Unit
		46.5	 Management of Seizures in Neurocritical Care Unit
			46.5.1	 Seizures Prophylaxis
			46.5.2	 Treatment of Seizures
		46.6	 Conclusions
		References
	47: Brain Tumors and Neurocritical Care
		47.1	Introduction
		47.2	 Decongestant Therapy and Treatment of Intracranial Hypertension (ICH)
		47.3	 Intravascular Thrombosis and Thromboembolism
		47.4	 Antiulcer Gastroprotective Therapy (GPT)
		47.5	 Vegetative Instability, Sympathetic Hyperactivity, and Hypercatabolism
		47.6	 Perioperative Period in Patients with Pituitary Tumors
		47.7	 Violations of Thermoregulation
		47.8	 Perioperative Period in Patients with Posterior Fossa Tumors
		References
	48: Spinal Surgery and Neurocritical Care
		48.1	 Introduction
		48.2	 Airway and Respiratory System
			48.2.1	 Airway Complications
			48.2.2	 Extubation Process
		48.3	 Cardiovascular System
		48.4	 Neurological System
		48.5	 Pain
		48.6	 Venous Thromboembolism
		48.7	 Perioperative Management of Patients with Acute Traumatic Spinal Cord Injury
			48.7.1	 Spinal Immobilisation
			48.7.2	 Airway Management
			48.7.3	 Respiratory Management
			48.7.4	 Cardiovascular Complications and Management
			48.7.5	 Autonomic Dysreflexia (AD)
			48.7.6	 Thromboprophylaxis
			48.7.7	 Gastrointestinal Management
			48.7.8	 Other Complications
			48.7.9	 Pain Management
			48.7.10 Steroids in SCI
		References
	49: Vascular Neurosurgery (Aneurysm) and Neurocritical Care
		49.1	 Introduction
		49.2	 Diagnosis of aSAH
		49.3	 Outcome Prediction Based on Severity of aSAH Grading
		49.4	 Early Brain Injury
		49.5	 Stabilisation
		49.6	 ICU Concerns and Complications
			49.6.1	 Rebleeding
			49.6.2	 Blood Pressure Control
			49.6.3	 Hydrocephalus
			49.6.4	 Raised Intracranial Pressure
			49.6.5	 Seizures
			49.6.6	 Fever
			49.6.7	 Respiratory Complications
			49.6.8	 Cardiac Complications
			49.6.9	 Intravascular Fluid and Electrolyte Abnormalities
			49.6.10 Cerebral Vasospasm and Delayed Cerebral Ischaemia
		49.7	 Prevention
		49.8	 Management
		49.9	 Other Neurocritical Care Concerns
			49.9.1	 Deep Vein Thrombosis
			49.9.2	 Anaemia
			49.9.3	 Glucose Control
			49.9.4	 Nutritional Support
			49.9.5	 Hypothalamic-Pituitary-Adrenal Axis Dysfunction
		49.10	 Post-aSAH Recovery—Cognitive Aspect
		49.11	 Conclusion
		References
	50: Vascular Neurosurgery - Cerebro-vascular Malformations and Neurocritical Care
		50.1	 Introduction
			50.1.1	 Cavernous Malformations
			50.1.2	 Developmental Venous Anomalies
			50.1.3	 Capillary Telangiectasias
			50.1.4	 Arteriovenous Malformations (AVMs)
			50.1.5	 Moyamoya Disease
			50.1.6	 Dural Arteriovenous Fistulas (DAVF)
			50.1.7	 Carotid-Cavernous Fistulas (CCF)
		50.2	 Arteriovenous Malformations (AVMs)
			50.2.1	 Clinical Case
			50.2.2	 Discussion
				Clinical Manifestations
				Treatment
				Anesthetic Management
				Postoperative Care
		50.3	 Moyamoya Disease
			50.3.1	 Clinical Case
			50.3.2	 Discussion
				Clinical Manifestations
				Treatment
				Anesthetic Management
				Postoperative Care
		References
	51: Ischemic Stroke Management in the ICU
		51.1	Introduction
		51.2	 Brief Case History
		51.3	 Neuro-Specific ICU Care
			51.3.1 Neuro Checks
			51.3.2 Seizure Prophylaxis
			51.3.3 ICP Management
			51.3.4 Medical Management
			51.3.5 Surgical Management
		51.4	 Multimodal Monitoring
		51.5	 General ICU Care
			51.5.1 General ICU Management
			51.5.2 Airway Management
			51.5.3 Blood Pressure Management
			51.5.4 Blood Glucose Management
			51.5.5 Temperature Management
			51.5.6 Ulcer Prophylaxis
			51.5.7 Urine Tract Infection (UTI) Prevention
			51.5.8 Deep Venous Thrombosis (DVT) Prevention
			51.5.9 Dysphagia
			51.5.10 Nutrition
		51.6	 Stroke-Specific Complications
			51.6.1 Suspected Intracranial Symptomatic Bleed
			51.6.2 Angioedema from Rt-PA/TNK
		51.7	 Restarting Antithrombotic and Anticoagulation Poststroke
		51.8	 Cerebellar Strokes
		51.9	 Conclusion
		References
	52: Acute Hemorrhagic Stroke and Neurocritical Care
		52.1	 Introduction
		52.2	 Risk Factors
			52.2.1 Hypertensive Vascular Change
			52.2.2 Cerebral Amyloid Angiopathy (CAA)
			52.2.3 Genetic
			52.2.4 Corticovenous Occlusion
		52.3	 Causes of ICH
		52.4	 Common Sites of ICH
		52.5	 Mechanisms for ICH-Related Brain Injury
		52.6	 Diagnosis
			52.6.1 History
			52.6.2 Symptoms and Signs Related to the Site of ICH
		52.7	 Laboratory Investigations
		52.8	 Investigations
		52.9	 Imaging (Table 52.3)
		52.10	 Treatment
			52.10.1 Initial Management
			52.10.2 BP Management
			52.10.3 Coagulopathy-Related ICH
			52.10.4 Seizure Management
			52.10.5 Cerebral Edema and ICP
			52.10.6 Surgical Management
			52.10.7 General Management
		52.11	 Prognosis
		52.12	 Conclusion
		References
	53: Myasthenia Gravis and Neurocritical Care
		53.1	 Introduction
		53.2	 Pathogenesis
			53.2.1	 Autoantibodies
			53.2.2	 Thymus Gland
		53.3	 Fatigable Weakness—Physiology
		53.4	 Clinical Characteristics
		53.5	 Long-Term Outcome
		53.6	 Diagnostics
		53.7	 Treatment
			53.7.1	 Symptomatic (Nonimmune) Treatment
		53.8	 Immune-Directed Therapy
			53.8.1	 Short-Term Immune-Directed Therapies
		53.9	 Long-Term Immune-Directed Therapies
		53.10	 Newer Agents for Management of Myasthenia Gravis
		53.11	 Special Therapeutic Situations: Myasthenic Crisis
		53.12	 Conclusion
		References
	54: Guillain-Barré Syndrome and Neurocritical Care
		54.1	 Introduction
		54.2	 Pathogenesis
		54.3	 Clinical Symptoms
		54.4	 Diagnosis
			54.4.1	 Diagnostic Criteria
			54.4.2	 Differential Diagnosis
		54.5	 Treatment
			54.5.1	 ICU Admission
			54.5.2	 General Supportive Care
			54.5.3	 Immunotherapy
				Plasmapheresis
				Intravenous Immune Globulin
				Indications for Immunotherapy
				Selection of Modality
			54.5.4	 Treatment-Related Fluctuations
			54.5.5	 Low Cost Alternatives for Treatment
		54.6	 Outcome
		References
	55: Movement Disorders in Neurocritical Care
		55.1	 Introduction
		55.2	 Approach
		55.3	 Classification
		55.4	 Hypokinetic Movement Disorders
			55.4.1	 Acute Parkinsonism
			55.4.2	 Neuroleptic Malignant Syndrome (NMS)
			55.4.3	 Parkinsonism Hyperpyrexia Syndrome (PHS)
			55.4.4	 Lethal Catatonia (LC)
			55.4.5	 Malignant Hyperthermia (MH)
		55.5	 Dystonic Movement Disorders
			55.5.1	 Status Dystonicus (SD)
			55.5.2	 Drug-Induced Acute Dystonic Reactions
				Management
		55.6	 Hyperkinetic Movement Disorders
			55.6.1	 Hemiballism-Hemichorea
			55.6.2	 NMDA Receptor Encephalitis (Autoimmune Orobuccolingual Dyskinesia)
			55.6.3	 Motor Fluctuations and Dyskinesia in Parkinson Disease
			55.6.4	 Psychosis in Parkinson Disease (PD)
			55.6.5	 Tic Status
			55.6.6	 Myoclonus
			55.6.7	 Serotonin Syndrome (SS)
				Post-Hypoxic Myoclonus
				Myoclonus in Other Conditions
		55.7	 Airway Emergencies
			55.7.1	 Laryngeal Adductor Dystonia
			55.7.2	 Laryngeal Abductor Paralysis in Multiple System Atrophy
		55.8	 Conclusion
		References
	56: Meningitis/Encephalitis and Neurocritical Care
		56.1	 Introduction
		56.2	 Community Acquired Acute Bacterial Meningitis (CA-ABM)
		56.3	 Health Care-Associated Meningitis and Ventriculitis (HA-MV)
		56.4	 Acute Aseptic Meningitis (AAM)
		56.5	 Tubercular Meningitis (TBM)
		56.6	 Herpes Simplex Encephalitis (HSE)
		56.7	 Cryptococcal Meningitis (CM)
		56.8	 Japanese B Encephalitis (JE)
		56.9	 Conclusion
		References
Part VIII: Special Considerations in Neurocritical Care
	57: Pediatric Patients and Neurocritical Care
		57.1	 Introduction
		57.2	 PNCC Subspecialty
		57.3	 Physiological Considerations in Children
		57.4	 General Approach to Pediatric Neurocritical Care
		57.5	 Multimodal Neuromonitoring
		57.6	 Important Pediatric Neurocritical Care Conditions
			57.6.1	 Traumatic Brain Injury
			57.6.2	 Stroke
			57.6.3	 Status Epilepticus
			57.6.4	 Central Nervous System Infections
				Acute Bacterial Meningitis
				Aseptic Meningitis and Encephalitis
		57.7	 Conclusion
		References
	58: Geriatric Neurocritical Care
		58.1	 Introduction
		58.2	 Frailty in Geriatrics
		58.3	 Frailty and Critical Care
		58.4	 Neurocritical Care and Geriatric Outcomes
			58.4.1	 Frailty and Traumatic Brain Injury
			58.4.2	 Decompressive Craniectomy
			58.4.3	 Mechanical Thrombectomy
			58.4.4	 Post-neurocritical Care Morbidity and Mortality
			58.4.5	 Immunosuppression in ICU
		58.5	 Conclusion
		References
	59: Pregnant Patients and Neurocritical Care
		59.1	 Introduction
		59.2	 Special Concerns in Pregnancy
		59.3	 Imaging Modalities
		59.4	 Contrast
			59.4.1	 Iodinated Agents
			59.4.2	 Gadolinium-Based Contrast Agents
		59.5	 Neurological Conditions in Pregnancy
			59.5.1	 Cerebrovascular Disorders (CVD)
				Management
			59.5.2	 Hypertensive Disorders of Pregnancy
				Blood Pressure Management
				Management of Eclampsia
			59.5.3	 Intracranial Neoplasms, Cerebral Edema, Intracranial Hypertension
				Management
			59.5.4	 Seizures
				Management
			59.5.5	 Postpartum Angiopathy
			59.5.6	 Posterior Reversible Encephalopathy Syndrome (PRES)
			59.5.7	 Ventriculoperitoneal Shunt Malfunction
				Management
			59.5.8	 Myasthenia Gravis (MG)
			59.5.9	 Cardiac Arrest and Hypoxic Brain Injury
		59.6	 Recent Developments in Neurocritical Pregnant Patients
			59.6.1	 Ketamine
			59.6.2	 Immunomodulators and Immunosuppressants
		59.7	 Conclusion
		References
Part IX: Ethics in Neurocritical Care
	60: Ethical Issues in Neurocritical Care
		60.1	 Introduction
		60.2	 Principles of Ethics
			60.2.1	 Informed Consent
			60.2.2	 Truth Telling
			60.2.3	 Confidentiality
			60.2.4	 Distributive Justice
		60.3	 Dilemmas in Ethical Practice
			60.3.1	 Role of Advance Directives and Surrogate Decision-Maker
			60.3.2	 Prognostication
			60.3.3	 Medical Futility
			60.3.4	 Conflicts in Organ Donation
			60.3.5	 Ethical Decision-Making Model
		References
	61: Diagnosing Brain Death
		61.1	 Introduction
		61.2	 Brain Death or Brain Stem Death?
		61.3	 Determination of Brain Death
		61.4	 Ancillary Testing
			61.4.1	 Tests Based on Electrophysiology of the Brain
			61.4.2	 Tests Based on Blood Flow Evaluation of the Brain
		61.5	 Special Situations
			61.5.1	 Brain Death Diagnosis in Pediatric Population
			61.5.2	 Brain Death Diagnosis in Patients on Targeted Temperature Management
		61.6	 Conclusion
		References
	62: Brain Death and Organ Donation
		62.1	 Introduction
		62.2	 Potential Organ Donor [6]
			62.2.1	 Historic Events [7–9]
			62.2.2	 What Does Brain Death Mean?
			62.2.3	 How Does Brain Death Occur [7, 8]
		62.3	 Determination of Brain Death/Tests for Brain Stem Death Certification [6–9, 12, 13]
		62.4	 Absent Respiratory Efforts in the Presence of Hypercarbia [12, 14] (Apnea Test)
			62.4.1	 Steps for Apnea Test
		62.5	 Interpretation [12, 14]
		62.6	 Queries About Apnea Test [1, 14, 15]
		62.7	 Is Consent Necessary for Apnea Test?
		62.8	 Troubleshooting During Performance of Apnea Test [1, 12, 14]
			62.8.1	 Observations which Are Compatible and Incompatible with Brain Stem Death
		62.9	 Ancillary Tests [1, 8, 13]
		62.10	 Legal Aspects in India for Certification of Brain Death [1, 10, 13, 15, 16]
			62.10.1	 Who Can Certify and How Many Doctors Required? [1, 10, 13, 16]
		62.11	 Summary
		References
Part X: Procedures in Neurocritical Care
	63: External Ventricular Drain
		63.1	 Introduction
		63.2	 Indications
		63.3	 Insertion Procedure
		63.4	 Management of EVD
			63.4.1	 Continuous Versus Intermittent EVD Drainage
			63.4.2	 EVD in SAH
			63.4.3	 EVD in TBI
			63.4.4	 EVD in ICH/IVH
			63.4.5	 Perioperative Management of EVD [3]
		63.5	 EVD System and Troubleshooting
			63.5.1	 Accidental Disconnection
			63.5.2	 Drain Occlusion
			63.5.3	 CSF Overdrainage
			63.5.4	 CSF Leak
		63.6	 EVD and Infection
		63.7	 Weaning and EVD Removal
		63.8	 Ommaya Reservoir
		63.9	 EVD and Thromboprophylaxis
		63.10	 Conclusion
		References
	64: Lumbar Drain
		64.1	 Introduction
		64.2	 Brief History
		64.3	 Relevant Anatomy
		64.4	 Indications
			64.4.1	 Craniotomy
			64.4.2	 Endoscopic Skull Base Surgery
			64.4.3	 CSF Leak
			64.4.4	 Thoracoabdominal Aortic Surgery
		64.5	 Contraindications
		64.6	 Technique
			64.6.1	 Preprocedure Preparation
			64.6.2	 Positioning and Equipment Setup
			64.6.3	 CSF Drainage
			64.6.4	 Postprocedure Care
		64.7	 Complications
		64.8	 Management of Complications
			64.8.1	 Headache: Postdural Puncture Headache
			64.8.2	 Cerebral Herniation
			64.8.3	 Infection
			64.8.4	 Catheter Shearing and Retained Catheter
			64.8.5	 Spinal Cord Injury/Paresthesia
			64.8.6	 Severe Pre-existing CSF Leak
		References
	65: Percutaneous Tracheostomy
		65.1	 Introduction
		65.2	 Indications
		65.3	 Contraindications
		65.4	 Anatomy
			65.4.1	 Relationship with Surrounding Structures
			65.4.2	 Anatomic Landmarks for Tracheostomy
		65.5	 Techniques for Insertion of PDT
			65.5.1	 Comparison of Different PDT Techniques
		65.6	 Preparation and Steps of PDT
		65.7	 Procedural Adjuncts
		65.8	 Special Considerations of PDT in Neurological Patients
		65.9	 Areas Requiring Special Considerations
		65.10	 Decannulation
		65.11	 Post Tracheostomy Care
		65.12	 Complications and Management
		65.13	 Conclusion
		References
	66: Bronchoscopy in Neuro ICU
		66.1	 Introduction
		66.2	 Indications in Neuro ICU
		66.3	 The Procedure
		66.4	 Bronchoscopy Safety Checklist
		66.5	 Contraindications
		66.6	 Complications
		66.7	 Bronchoscopy in Critically Ill Neuro Patient
		66.8	 Conclusion
		References