Consultative Neurocritical Care

Critically ill patients who are suffering from non-neurological illness and organ dysfunction in an ICU environment are prone to secondary injuries along the neuraxis. Structural and functional disturbances can manifest all the way from the brain to the peripheral nervous system. The most common neurological disorders seen in non-neurological ICUs include delirium, altered mentation, and critical illness neuromyopathy, but more acute conditions are encountered, such as ischemic and hemorrhagic strokes, as well as seizures. Besides providing consultation for management decisions, neurologists are also an integral part of neuroprognostication in critically ill patients. This chapter outlines the basic principles of consultative neurocritical care by describing prerequisites and techniques for performing an adequate and ICU-focused neurological exam. The chapter also addresses several common questions asked of the neurology consultant and provides a practical approach to adequately answer these. Fundamental aspects of neuroprognostication are also elaborated.