CICM - Neurocritical care
Acute onset motor neuropathy - ANS-AIDP (GBS and variants)
Acute intermittent porphyria
Transverse myelitis
Poliomyelitis
Botulism
Snake bite
CSF testing - ANS-1. glucose
- insensitive
2. b2-transferrin
-highly specific and sensitive
- produced by CSF neuraminidase
- isomer of b1 transferrin (iron transporter)
Jugular bulb desaturation: Mx - ANS-Check measurement on CO-oximetry
Check ABG, correct hypoxia
Check MAP, correct hypotension
Check Hb, correct anaemia
Check ICP, correct if high
Check EEG, control fitting
Jugular bulb hyperaemia: Mx - ANS-Check measurement on CO-oximetry
reduced excessive CBF - normalise PaCO2
exclude reduced CMRO2, check ICP
Consider CT scan
Jugular venous bulb saturation - ANS->75% hyperaemia
55-75% normal
50-55% critical SjO2
<50% pathological
Polyuria post head injury - ANS-Cranial diabetes insipidus
- high seOsm, low urOsm, high Na
Ethanol intoxication
- high osmolar gap, high EtOH
Cerebral salt-wasting
- iso-osmolar, hyponatraemic
Acute onset motor neuropathy - ANS-AIDP (GBS and variants)
Acute intermittent porphyria
Transverse myelitis
Poliomyelitis
Botulism
Snake bite
CSF testing - ANS-1. glucose
- insensitive
2. b2-transferrin
-highly specific and sensitive
- produced by CSF neuraminidase
- isomer of b1 transferrin (iron transporter)
Jugular bulb desaturation: Mx - ANS-Check measurement on CO-oximetry
Check ABG, correct hypoxia
Check MAP, correct hypotension
Check Hb, correct anaemia
Check ICP, correct if high
Check EEG, control fitting
Jugular bulb hyperaemia: Mx - ANS-Check measurement on CO-oximetry
reduced excessive CBF - normalise PaCO2
exclude reduced CMRO2, check ICP
Consider CT scan
Jugular venous bulb saturation - ANS->75% hyperaemia
55-75% normal
50-55% critical SjO2
<50% pathological
Polyuria post head injury - ANS-Cranial diabetes insipidus
- high seOsm, low urOsm, high Na
Ethanol intoxication
- high osmolar gap, high EtOH
Cerebral salt-wasting
- iso-osmolar, hyponatraemic
