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BRAINSTEM DYSFUNCTION IN CRITICALLY ILL PATIENTS
Brain injured patients
Intensive care unit
Sedation
Brainstem reflexes
Disorders of consciousness
Autonomic nervous system
Neurological respiratory failure
Immune reflex
Auditory and somatosensory evoked potentials and electroencephalogram
Autor
Afiliación
Department of Neurology, Neuro-ICU, Sorbonne University, APHP Pitié-Salpêtrière Hospital, Paris, France./ Medical ICU, Cochin Hospital, AP-HP, Paris, France.
Department of Neuro-ICU, GHU-Paris, Paris-Descartes University, Paris, France./ Laboratory of Experimental Neuropathology, Pastuer Institute, Paris, France.
Department of Physiology, Clinical Neurophysiology Unit, APHP, Raymond Poincaré Hospital, University of Versailles Saint Quentin en Yvelines, Garches, France.
Department of Intensive Care Medicine, Saint-Joseph Hospital, Paris, France.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em Medicina Intensiva./ Intensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer./ D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brasil.
Department of Neurology, Neuro-ICU, Columbia University, New York, NY, USA.
Department of Neurology, Neuro-ICU, Sorbonne University, APHP Pitié-Salpêtrière Hospital, Paris, France./ Department of Neurology, Neuro-ICU, Columbia University, New York, NY, USA./ Institut du Cerveau et de la Moelle épinière, ICM, INSERM UMRS 1127, CNRS UMR 7225, Pitié- Salpêtrière Hospital, Paris, France.
Department of Neuro-ICU, GHU-Paris, Paris-Descartes University, Paris, France./ Laboratory of Experimental Neuropathology, Pastuer Institute, Paris, France.
Department of Neuro-ICU, GHU-Paris, Paris-Descartes University, Paris, France./ Laboratory of Experimental Neuropathology, Pastuer Institute, Paris, France.
Department of Physiology, Clinical Neurophysiology Unit, APHP, Raymond Poincaré Hospital, University of Versailles Saint Quentin en Yvelines, Garches, France.
Department of Intensive Care Medicine, Saint-Joseph Hospital, Paris, France.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em Medicina Intensiva./ Intensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer./ D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brasil.
Department of Neurology, Neuro-ICU, Columbia University, New York, NY, USA.
Department of Neurology, Neuro-ICU, Sorbonne University, APHP Pitié-Salpêtrière Hospital, Paris, France./ Department of Neurology, Neuro-ICU, Columbia University, New York, NY, USA./ Institut du Cerveau et de la Moelle épinière, ICM, INSERM UMRS 1127, CNRS UMR 7225, Pitié- Salpêtrière Hospital, Paris, France.
Department of Neuro-ICU, GHU-Paris, Paris-Descartes University, Paris, France./ Laboratory of Experimental Neuropathology, Pastuer Institute, Paris, France.
Resumen en ingles
The brainstem conveys sensory and motor inputs between the spinal cord and the brain, and contains nuclei of the cranial nerves. It controls the sleep-wake cycle and vital functions via the ascending reticular activating system and the autonomic nuclei, respectively. Brainstem dysfunction may lead to sensory and motor deficits, cranial nerve palsies, impairment of consciousness, dysautonomia, and respiratory failure. The brainstem is prone to various primary and secondary insults, resulting in acute or chronic dysfunction. Of particular importance for characterizing brainstem dysfunction and identifying the underlying etiology are a detailed clinical examination, MRI, neurophysiologic tests such as brainstem auditory evoked potentials, and an analysis of the cerebrospinal fluid. Detection of brainstem dysfunction is challenging but of utmost importance in comatose and deeply sedated patients both to guide therapy and to support outcome prediction. In the present review, we summarize the neuroanatomy, clinical syndromes, and diagnostic techniques of critical illness-associated brainstem dysfunction for the critical care setting.
Palabras clave en ingles
Brainstem dysfunctionBrain injured patients
Intensive care unit
Sedation
Brainstem reflexes
Disorders of consciousness
Autonomic nervous system
Neurological respiratory failure
Immune reflex
Auditory and somatosensory evoked potentials and electroencephalogram
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