Introduction
Anti-N-methyl-D-aspartate receptor (Anti-NMDAR) encephalitis in children has become a formidable, yet important disease for critical care physicians to diagnose, manage clinical manifestations, and ultimately treat. Anti-NMDAR encephalitis was originally described in 2005 in four women with ovarian teratomas, presenting with seizures, acute psychiatric disturbances, cognitive deficits, decreased sensorium, autonomic instability and hypoventilation [1]. Dalmau et al. in 2007 diagnosed these women and 8 others after demonstrating specific autoantibodies to the NMDAR; namely a neuronal cell surface protein that was shown to be the NR1 subunit of the receptor [2]. Since the first reported cases and discovery of anti-NMDAR encephalitis, this autoimmune disease has surpassed all viral etiologies and has been recognized as the second most common entity after acute demyelinating encephalitis (ADEM) [2, 3]. Likewise, the estimated mortality in one series for anti-NMDAR encephalitis is 4% with a median mortality after 3 ½ months of symptoms [4]. Although there have been over 600 cases reported in the literature, further considerations for critical care physicians have been lacking [5-11]. In this review of the current literature we discuss the pathophysiology, diagnosis, clinical manifestations and critical care management of anti-NMDAR encephalitis with clinical recommendations from our center’s experience.
Discussion
Epidemiology, Clinical Manifestations, Diagnosis, and Treatment
Anti-NMDAR encephalitis affects both males and females, although has a higher incidence among females (75% of all cases) [8, 12-16]. Although it was originally described as a paraneoplastic disease with 58% of patients showing evidence of...
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Anti-NMDAR encephalitis is a commonly encountered adult and pediatric critical care diagnosis. A multi-disciplinary approach in a patient / family centered model assists patients and their families in coping with a long recovery. Critical care physicians are instrumental in the coordination of the care of these patients. Furthermore, careful understanding of the clinical features of the disease, diagnosis, and treatment interventions is paramount for patient prognosis. Finally, early rehabilitation after careful consideration for tracheostomy and gastrostomy placement may further improve functional outcomes. Future studies comparing the critical care management of both pharmacologic approaches and non-pharmacologic interventions of autonomic dysfunction, movement disorders, and cardiac arrhythmias will be important in improving patient care and outcomes.
Delirium in the Intensive Care Unit (ICU) has become a genuine phenomenon and can be problematic for the patient and the staff caring for them. Delirium occurs when a patient is placed in an unfamiliar environment and has to endure the stress of not just the hospitalization but the stimuli of the environment, which can cause disturbances in consciousness. Patients can become confused, anxious, and agitated; making this difficult for the staff to correctly diagnosis and care for them. Sleep deprivation and environmental factors along with neurotransmitters are strongly related to the occurrence of ICU delirium. ICU staff needs to become more educated on prevention, detection, and proper treatment for the patient experiencing this condition.
WORLD HEALTH ORGANISATION, 1997. Tabular list of neurological and related disorders. In: WORLD HEALTH ORGANISATION, ed. Application of the International Classification of Diseases to Neurology. Canada: World Health Organisation, p. 153.
problems within the specific ion channels known to cause the disease. The goal of the
Polio is a viral disease. It cripples thousands of people and infects even more every year. Even though millions are inoculated, and the polio disease has been successfully purged from hundreds of countries still thousands of people and developing countries are infected and still people are dying. According to the World Health Organization (WHO) polio affects the Central Nervous System, or CNS; by infesting the intestines and transmitting it into the nerves thought the blood vessels. There the virus spreads through the nerve cells to the brain stem or other motor units, while forever damaging the nerves.
Think about it, an average teen in this world has just been diagnosed with a type of incurable dementia which will forever change his or her life. Frontotemporal dementia (FTD) is one of the less common forms of dementia. It is when the nerve cells in the frontal lobe die and over time the brain tissue shrinks. Frontotemporal dementia is mostly found in people who are in their teens or twenties. It can affect young people in a very negative way. They start to get aggressive and as the disease gets worse they lose friends and have a difficult time in school and understanding things. Frontotemporal dementia is a rare disease that is on the rise and affects the people of the younger generation.
Mosquitoes, fever and even death may be some of the things that come to mind when we're asked to think about West Nile Virus. Many of us would consider mosquitoes a small trade-off for what the summertime provides, but what if there were more at risk than a bump above your skin and an itch? In a not so distant past West Nile Virus ascended into news broadcasts all throughout the country and alarming it's residents. Today however, that all seems to be an afterthought. The intentions today are to cover the first found cases of West Nile Virus, the symptoms of West Nile Virus, and finally West Nile Virus' impact on the United States. Through the research here, the hope is that we can all have a better understanding of how West Nile Virus works.
Envision a life consumed by grayness and misfortune, slowly weakening the body from the inside with no proof of existence other than symptoms of a common cold. Dwindling away as skin begins to cling to bone, this monster, formally addressed as the Poliomyelitis (Polio) disease, finds its way to the nerves of the body as well as the grey areas of the spinal cord, leaving its host with dreadful affects throughout the body.Since its discovery in 1905, Polio has caused several epidemics throughout the years leaving many permanently paralyzed or even dead. Thankfully, scientists created the polio vaccination which lead to the nearly complete eradication of this disease. However, In order to ensure this disease does not spread as it once did before, people must come to understand Polio’s etiology, history and modern day epidemiology, as well as its proper response to treatment.
A patient should remain on bed rest and receive well balanced nutrition. Patients should be restricted from school and or work until fever is reduced and jaundice diminishes. If the patient is vomiting and or has diarrhea, they can be treated with antiemetic medications. Also, adequate water intake is necessary.
Hydrocephalus is a genetic disorder commonly described as “water on the brain.” In actuality, this is a condition in which there is an excessive accumulation of cerebrospinal fluid (CSF), a clear watery fluid that surrounds the space between the brain and spinal cord, in the brain. Normally, the production together with the absorption process of CSF is specifically balanced to ensure that the brain tissue remains buoyant, that nutrients can be delivered and waste removed, and that there is a compensation for changes in intracranial blood volume. Hydrocephalus blocks this balanced flow as well as absorption, and on account of CSF being produced continuously, 16 oz each day to be exact, the blocking creates a surplus of CSF resulting in the said pressure against the brain tissue. The surplus accretion of CSF additionally motivates ventricular dilation in which the gaps between the brain, known as ventricles, abnormally widen.
This paper is going to discuss the condition Epilepsy. Epilepsy is defined as a disorder of the brain characterized by the recurrence of unprovoked seizures (Shorvon, 2009). Epilepsy starts in your brain, the brain is like a computer, it is made up of a mass of cells, called neurons, which connect to each other in very complicated ways (Routh, 2004). Electrical messages are constantly being passed from one neuron to another down nerves to the muscles in the body (Mair, 2004). If a person has epilepsy, these cells sometimes send a sudden, unexpected burst of electrical impulses, which causes a seizure (Routh, 2004). When the seizure finishes the brain behaves normally again. For some people with epilepsy these seizures happen every day. For others they may happen only once or twice a year (Routh, 2004). There are over 40 different types of seizure and each person is slightly different, but there are a few common types (Routh, 2004). Generalized seizures which affect the whole brain and partial seizures which affect a small part of the brain (Miller, 2013). The most common types of ge...
(10) Levi B.H., Thomas N.J., Green M.J., Rentmeester C.A. & Ceneviva G.D. (2004), jading in the paediatric intensive care unit: implications for healthcare providers of medically complex children. Paediatric Critical Care Medicine 5 (3), 275–277. (11) Ward. E [1990] Ch. 359.
NF is very unpredictable and there is many manifestations of severity. There is no cure for NF even though Both NF1 and NF2 have been identified. (Neurofibromatosis Network) NF is not contagious. NF can cause growth of non-cancerous tumors on nerve tissues that will produce skin and bone abnormalities. Some people are widely affected by NF. Where some are unaffected and then there are some who are severely disabled. Neurofibromas are tumors that are usually non-cancerous that grown along the nerves in the on or under the skin. The usuall...
According to the U.S. National Library of Medicine, epilepsy is defined as “a brain disorder in which a person has repeated seizures (convulsions) over time.” Abnormal electrical activity in the brain causes these seizures. Epilepsy can result in learning difficulties, choking (during seizures), injuries, and even brain damage. Most people diagnosed with epilepsy will continue to have it throughout their lives. There is no cure for epilepsy but the disease can be controlled using anticonvulsant drugs (Epilepsy).
is characterized by “deterioration in the level of consciousness, with lethargy, decrease in arousal and headache. The timing of the development of cerebral edema is variable, within most cases occurring 4 to 12 hours after starting treatment. Several case reports showed the presence of cerebral edema before the initiation of therapy. A method of clinical diagnosis based on bedside evaluation of a neurological state in DKA have been developed” (Pandey).
Dementia is defined by the World Health Organization as a syndrome due to damage of the brain cells that most often chronic and progressive in nature. Some of the cortical functions that become impaired include memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgment. Other manifestations that may accompany this disease are deterioration in emotional control, social behavior or motivation (Ouldred & Bryant, 2009) Dementia is not a normal part of aging, however it occurs most frequently in the older population. Fifteen percent of Americans over the age of sixty-five have dementia, and as the average life span continues to increase, so will the number of those affected by dementia (Fredman, James, Johnson, Scholz, & Weuve, 2012). The purpose of this paper is to discuss the pathophysiology, risk factors, symptoms, and treatment options for different types of dementia.