Neurological Disorders in Critical Illness

Czech version

Authors: prof. MUDr. Josef Bednařík, CSc.
Authors‘ workplace: LF MU a FN Brno ; Ne urologická klinika
Published in: Cesk Slov Neurol N 2008; 71/104(5): 511-529
Category: Minimonography

Poděkování: a utor děkuje prof. MUDr. Zdeňku Lukášovi, CSc., za poskytnutí histopatologických nálezů.

Overview

Critical illness is usu ally defined as a conditi on characterised by failure of one or more organs or systems as a result of a seri o us dise ase or tra uma and usu ally accompani ed by systemic inflammatory response syndrome. Among ca uses of critical illness are infecti ons, usu ally respiratory ones, tra umas, burns, gre at surgery or primary failure of one organ including central nervo us system or ne uromuscular failure. Original concept of sepsis as an inappropri ate mobilizati on of defence mechanisms against virulent infecti on was modifi ed by a concept of systemic inflammatory response syndrome as uncontrolled wide inflammatory response against not only infecti on and le ading into multiple organ failure. Failure of cerebral functi ons in the form of diffuse encephalopathy – encephalopathy in critical illness – is usu ally an integral part of multiple organ failure. Among key signs are decre ased level of consci o usness and disordered cognitive functi ons (especi ally attenti on, cogniti on and ori entati on). Most scoring systems of multiple organ failure use the Glasgow coma scale to score the central nervo us system failure. The aeti ology of encephalopathy in critical illness is probably multi- factori al and overlaps with that of eti ologically unspecific syndrome of deliri um. Encephalopathy in critical illness sho uld be differenti ated from infecti o us encephalitis and acute para- infecti o us a uto immune encephalopathi es. Ne uromuscular disorders in critically ill pati ents demonstrate especi ally as a new we akness (“critical illness we akness”). Beside exacerbati on of pre- existing ne uromuscular disorder and persistent pharmacological blockade of ne uromuscular transmissi on ca used by non‑depolarising muscle blocking agents, there exists the newly recognised ca use called polyne uropathy and myopathy of critical illness. These disorders affect to some extend at le ast half of critically ill pati ents. Aeti ology is probably multi- factori al. Systemic inflammatory response syndrome and multiple organ failure are probably among important eti ological factors. In critical illness myopathy, “functi onal denervati on” ca used by non‑depolarising muscle blocking agents and high doses of corticostero ids have additi onal effect. Both conditi ons are frequently associ ated in the same pati ent – critical illness polyne uromyopathy. In contrast to original concept of complicati ons of critical illness these conditi ons seem to be an integral part of multiple organ failure – a ne uromuscular failure – analogical to the failure of other organs and systems. Critical illness polyne uropathy and myopathy are important risk factors of prolonged morbidity and mortality in critically ill pati ents. Current state of art in the are a of aeti ology and pathogenesis of critical illness doesn’t enable the use of effective preventi on and tre atment of ne uromuscular disorders.

Key words:
critical illness – sepsis – multiple organ failure – encephalopathy – polyne uropathy – myopathy

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