Case 29

2020 ◽  
pp. 193-201
Author(s):  
Lucinda Barrett ◽  
Bridget Atkins
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Intensive Care ◽  
Care Setting ◽  
External Ventricular Drain ◽  
Acute Infection ◽  
Neurological Status ◽  
Intensive Care Setting ◽  
The Central Nervous System

Neurosurgical infections include those of devices such as external ventricular drains and permanent shunts (e.g. ventriculo-peritoneal and ventriculo-atrial). Organisms can form biofilm on the surface of such devices, sometimes sufficient to cause blockage. Patients may present with signs of meningitis or of shunt blockage. In the intensive care setting patients may have fever and/or deterioration in their neurological status. These infections are complex to manage as they usually require removal/revision of the device and delivery of high levels of antibiotics to the central nervous system. Each of these has risks and needs to be expertly managed. This case describes an acute infection in an external ventricular drain.

scholarly journals Reduced motoneuron excitability in a rat model of sepsis

2013 ◽  
Vol 109 (7) ◽  
pp. 1775-1781 ◽  
Author(s):  
Paul Nardelli ◽  
Jaffar Khan ◽  
Randall Powers ◽  
Tim C. Cope ◽  
Mark M. Rich
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Intensive Care ◽  
Motor Unit ◽  
Action Potentials ◽  
Cecal Ligation ◽  
Membrane Properties ◽  
Whole Body ◽  
Repetitive Firing ◽  
The Central Nervous System

Many critically ill patients in intensive care units suffer from an infection-induced whole body inflammatory state known as sepsis, which causes severe weakness in patients who survive. The mechanisms by which sepsis triggers intensive care unit-acquired weakness (ICUAW) remain unclear. Currently, research into ICUAW is focused on dysfunction of the peripheral nervous system. During electromyographic studies of patients with ICUAW, we noticed that recruitment was limited to few motor units, which fired at low rates. The reduction in motor unit rate modulation suggested that functional impairment within the central nervous system contributes to ICUAW. To understand better the mechanism underlying reduced firing motor unit firing rates, we moved to the rat cecal ligation and puncture model of sepsis. In isoflurane-anesthetized rats, we studied the response of spinal motoneurons to injected current to determine their capacity for initiating and firing action potentials repetitively. Properties of single action potentials and passive membrane properties of motoneurons from septic rats were normal, suggesting excitability was normal. However, motoneurons exhibited striking dysfunction during repetitive firing. The sustained firing that underlies normal motor unit activity and smooth force generation was slower, more erratic, and often intermittent in septic rats. Our data are the first to suggest that reduced excitability of neurons within the central nervous system may contribute to ICUAW.

scholarly journals Serum neurofilament light chain as outcome marker for intensive care unit patients

2020 ◽  
Author(s):  
Anna Lena Fisse ◽  
Kalliopi Pitarokoili ◽  
David Leppert ◽  
Jeremias Motte ◽  
Xiomara Pedreiturria ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Central Nervous System ◽  
Nervous System ◽  
Intensive Care ◽  
Light Chain ◽  
Neurofilament Light Chain ◽  
Icu Patients ◽  
Neurofilament Light ◽  
The Central Nervous System

Abstract Objective Neurofilament light chain (NfL) in serum indicates neuro-axonal damage in diseases of the central and peripheral nervous system. Reliable markers to enable early estimation of clinical outcome of intensive care unit (ICU) patients are lacking. The aim of this study was to investigate, whether serum NfL levels are a possible biomarker for prediction of outcome of ICU patients. Methods Thirty five patients were prospectively examined from admission to ICU until discharge from the hospital or death. NfL levels were measured longitudinally by a Simoa assay. Results NfL was elevated in all ICU patients and reached its maximum at day 35 of ICU treatment. Outcome determined by modified Rankin Scale at the end of the follow-up period correlated with NfL level at admission, especially in the group of patients with impairment of the central nervous system (n = 25, r = 0.56, p = 0.02). Conclusion NfL could be used as a prognostic marker for outcome of ICU patients, especially in patients with impairment of the central nervous system.

Extravascular foci ofTrypanosoma vivaxin goats: the central nervous system and aqueous humor of the eye as potential sources of relapse infections after chemotherapy

Parasitology ◽  
1988 ◽  
Vol 97 (1) ◽  
pp. 51-61 ◽  
Author(s):  
D. D. Whitelaw ◽  
P. R. Gardiner ◽  
M. Murray
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Choroid Plexus ◽  
Aqueous Humor ◽  
Acute Infection ◽  
Clinical Signs ◽  
Central Nervous System Involvement ◽  
Severe Illness ◽  
Diminazene Aceturate ◽  
The Central Nervous System

SUMMARYRelapse of parasitaemia after drug treatment of trypanosome infections is normally attributed to drug-resistance on the part of the parasite, under-dosage of the drug or reinfection of the host. In addition, inaccessibility of parasites to drug through sequestration in privileged extravascular sites has been shown in the past to occur withTrypanosoma brucei, and we have obtained evidence that extravascular foci ofT. vivaxcan also serve as a source of relapsing infections. Infection of goats with a West African stock ofT. vivaxresulted in severe illness, which was fatal if untreated. During the terminal stage of an acute infection, clinical signs of central nervous system involvement were apparent. Histologically, the choroid plexus was swollen and oedematous, and in some cases meningitis or meningoencephalitis was seen. Trypanosomes could be detected in the cerebrospinal fluid, and also extravascularly in the choroid plexus and meninges. In three cases they were present in the aqueous humor, associated with corneal cloudiness or opacity. Treatment of 2 goats with the trypanocidal drug diminazene aceturate eliminated parasitaemia, but infections in both relapsed about 6 weeks later, despite trypanosomes being undetectable in the bloodstream during the intervening period. We conclude that the relapse infections were caused by re-emergence of trypanosomes from the CNS and/or the eye, where sequestered parasites may have been inaccessible to the trypanocide.

scholarly journals The use of electroencephalography in patients with sepsis: A review of the literature

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Nikolaos-Dimitrios Pantzaris ◽  
Christina Platanaki ◽  
Konstantinos Tsiotsios ◽  
Ioanna Koniari ◽  
Dimitrios Velissaris
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Low Cost ◽  
Neurological Status ◽  
Neurological Complications ◽  
Brain Dysfunction ◽  
Review Of The Literature ◽  
Specific Test ◽  
Diagnosis And Prognosis ◽  
The Central Nervous System

AbstractSepsis-associated encephalopathy (SAE) is the term used to define brain dysfunction related to infections that are principally located outside the central nervous system (CNS). A number of published studies report that electroencephalography (EEG) has been used in the evaluation of patients with sepsis, alone or usually in combination, to evoked potentials and neuroimaging. This was in an effort to assess if EEG can be a tool in the diagnosis and monitoring of the neurological status in sepsis patients. Although there is no specific test for the diagnosis and prognosis of sepsis related encephalopathy, our literature review suggests that EEG has a role in the assessment of this clinical entity. Due to its low cost and simplicity in its performance, EEG could be a potential aid in the assessment of sepsis neurological complications even in the early, subclinical stages of the syndrome. The aim of this review is to summarize the published literature regarding the application and utility of electroencephalography in adult patients with sepsis.

Mucormycosis in diabetes

1997 ◽  
Vol 6 (5) ◽  
pp. 363-367 ◽  
Author(s):  
MA Hopkins ◽  
DM Treloar
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Acute Infection ◽  
Signs And Symptoms ◽  
Diabetic Woman ◽  
Critical Care Nursing ◽  
Appropriate Treatment ◽  
The Central Nervous System ◽  
The Brain ◽  
Care Nursing

Mucormycosis is a rare opportunistic infection caused by ubiquitous fungi typically found in soil, spoiled foods, bread, and dust. The acute infection most commonly is rhinocerebral and is associated with metabolic acidosis. Mucormycosis spreads quickly and can progress from the paranasal area to the brain in a few days. In the case presented, a young diabetic woman had diabetic ketoacidosis and classic signs and symptoms of mucormycosis. Even after aggressive and appropriate treatment with surgical debridement and IV administration of amphotericin B, the fungus invaded the central nervous system. This article discusses current methods of treating mucormycosis and important critical care nursing considerations for patients who have the infection.

Is It a New Syndrome or Due to Overstimulation in the ICU?

PEDIATRICS ◽  
1990 ◽  
Vol 86 (2) ◽  
pp. 324-324
Author(s):  
JEAN GARDNER COLE
Keyword(s):  
Intensive Care Unit ◽  
Central Nervous System ◽  
Nervous System ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Recent Article ◽  
Supportive Environment ◽  
The Central Nervous System

To the Editor.— A recent article by Perlman and Volpe in Pediatrics1 described a new syndrome of movement disorder in infants with severe bronchopulmonary dysplasia. I should like to take issue with these findings and feel that what Perlman and Volpe are describing is actually infants responding behaviorally to an overstimulating environment. This "new syndrome" is, I feel, what Als calls "the consequence of a mismatch of extrauterine environment and the capacity of the central nervous system of the fetal neonate which is adapted for an intrauterine existence"2 to deal with the onslaught of stimulation which it encounters in the noisy, chaotic environment of the average Neonatal Intensive Care Unit. The behaviors described in the article are seen routinely in preterm infants responding behaviorally to overstimulation.3 These behaviors become learned maladaptive responses to stress. They can be prevented or ameliorated by the provision of a more supportive environment, one which recognizes early signs of behavioral disorganization and responds by reducing the cause of the overstimulation, be it auditory, visual, tactile, or kinesthetic.4-6

scholarly journals Kinetics of Virus-Specific CD8+-T-Cell Expansion and Trafficking following Central Nervous System Infection

2003 ◽  
Vol 77 (4) ◽  
pp. 2775-2778 ◽  
Author(s):  
Norman W. Marten ◽  
Stephen A. Stohlman ◽  
Jiehao Zhou ◽  
Cornelia C. Bergmann
Keyword(s):  
Central Nervous System ◽  
T Cells ◽  
Nervous System ◽  
T Cell ◽  
Hepatitis Virus ◽  
Acute Infection ◽  
Central Nervous System Infection ◽  
Cervical Lymph Nodes ◽  
Cognate Antigen ◽  
The Central Nervous System

ABSTRACT CD8+ T cells control acute infection of the central nervous system (CNS) by neurotropic mouse hepatitis virus but do not suffice to achieve sterile immunity. To determine the lag between T-cell priming and optimal activity within the CNS, the accumulation of virus-specific CD8+ T cells in the CNS relative to that in peripheral lymphoid organs was assessed by using gamma interferon-specific ELISPOT assays and class I tetramer staining. Virus-specific CD8+ T cells were first detected in the cervical lymph nodes. Expansion in the spleen was delayed and less pronounced but also preceded accumulation in the CNS. The data further suggest peripheral acquisition of cytolytic function, thus enhancing CD8+-T-cell effector function upon cognate antigen recognition in the CNS.

scholarly journals Relationship between intensive care unit-acquired weakness, fatigability and fatigue: What role for the central nervous system?

2021 ◽  
Vol 62 ◽  
pp. 101-110
Author(s):  
Robin Souron ◽  
Jérôme Morel ◽  
Laurent Gergelé ◽  
Pascal Infantino ◽  
Callum G. Brownstein ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Central Nervous System ◽  
Nervous System ◽  
Intensive Care ◽  
The Central Nervous System

scholarly journals West Nile Virus Induced Cell Death in the Central Nervous System

Pathogens ◽  
2019 ◽  
Vol 8 (4) ◽  
pp. 215 ◽  
Author(s):  
Peng ◽  
Wang
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
West Nile Virus ◽  
Neuronal Damage ◽  
Acute Infection ◽  
The United States ◽  
West Nile ◽  
The Central Nervous System

West Nile virus (WNV), a mosquito-borne, single-stranded flavivirus, has caused annual outbreaks of viral encephalitis in the United States since 1999. The virus induces acute infection with a clinical spectrum ranging from a mild flu-like febrile symptom to more severe neuroinvasive conditions, including meningitis, encephalitis, acute flaccid paralysis, and death. Some WNV convalescent patients also developed long-term neurological sequelae. Neither the treatment of WNV infection nor an approved vaccine is currently available for humans. Neuronal death in the central nervous system (CNS) is a hallmark of WNV-induced meningitis and encephalitis. However, the underlying mechanisms of WNV-induced neuronal damage are not well understood. In this review, we discuss current findings from studies of WNV infection in vitro in the CNS resident cells and the in vivo animal models, and provide insights into WNV-induced neuropathogenesis.

Severe Bacillus cereus infection in a neonatal intensive care unit

2014 ◽  
Vol 3 (2) ◽  
Author(s):  
Clara Machado ◽  
Albina Silva ◽  
Maria J. Magalhães ◽  
Carla Sá ◽  
Eduarda Abreu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Central Nervous System ◽  
Nervous System ◽  
Intensive Care ◽  
Birth Weight ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Clinical Consequences ◽  
The Central Nervous System ◽  
Immunocompromised Status

AbstractInfections of the central nervous system (CNS) in neonates with very low birth weight (VLBW) may have major clinical consequences due to their immunocompromised status.

Sign in / Sign up

Export Citation Format

Share Document