Neurologic Complications of Critical Illness

This book is appropriate for neurologists, surgeons, internists, anesthesiologists, intensivists, and nurses who manage or provide consultations for critically ill patients. It is a comprehensive and detailed reference of neurologic complications, and is helpful, well organized, and indexed. Pathophysiologic mechanisms are typeset differently throughout the text, which also makes for rapid reference. The book is arranged in two different ways, first into chapters of neurologic symptoms such as altered mental status, seizures or weakness. Later it is organized into a list of neurologic complications found in specific disease processes (e.g. vasculitis, acid–base derangements, acute renal or hepatic failure) and complications of pregnancy and following environmental injuries and procedures (e.g. aortic or cardiac surgery or organ transplantation). The strength of this book is its comprehensive nature and extensive referencing, which is more than one might expect from a single author. One is hard pressed to find a neurologic entity in the intensive care unit (ICU) that is not covered. Each chapter is very thorough, but one of the strongest chapters in the book is that devoted to complications following organ transplantation. The weakness of this book is the same as that for any textbook and relates to the publishing process itself, whereby information presented in a book rapidly becomes outdated. For example, the potential of hypothermia as a neuroprotectant is alluded to, but more recent data reported in 2002 provide evidence that the use of hypothermia may improve outcomes [1,2]. In addition, not included in the book is recent information showing that tight glucose control in the ICU decreases the incidence of critical care polyneuropathy [3]. Practical management tips could be more clearly stated. This is a pitfall in writing a text that focuses on recognition and a description of complications rather than one that also encompasses management. The weakest chapter is that devoted to multisystem trauma. For example, in patients with head injury, it cannot be overstated that hypertension and/or increasing agitation may be indicators of increasing intracranial pressure, which should be addressed before the symptoms or signs themselves are treated with antihypertensive medication or sedation. Other topics that deserve greater attention include the following: coagulopathy and disseminated intravascular coagulopathy following head trauma, and attendant risk for enlarging hemorrhage and need for surgery; differences in types of intracranial monitors and their different associated risks for hemorrhage or infection; and the pitfalls of pentobarbital infusion such as hypotension, hypothermia and ileus. …