Potential Problems

Any issues with the brain, spine, or nerves can cause a number of problems. The nervous system is complex, and not all damage is reversible. Here are some difficulties with the brain, spine, and nerves that are seen in the MSICU:

Fever

Seizures

Cerebral Edema

Hematomas

Hydrocephalus

Hemorrhages

Subarachnoid hemorrhages

Aneurysms

Strokes

Decreased Level of Consciousness

Delirium

Paralysis

Trauma

Tumours

Coma

Guillain-Barré Syndrome (GBS)

 

Fever

Everyone has had a fever at some point in their lives. Normally, a fever is the body trying to fight off an infection by a bacteria or virus. Body temperature is regulated by an area of the brain called the hypothalamus. If this area of the brain is injured, inflamed or infected, fevers can becomes difficult to control. A fever that is too high for too long can cause further damage.

Seizures

A seizure happens when brain cells misfire and send chaotic signals to the rest of the body. Sometimes there are too many signals all at once, sending conflicting messages to the cells. Seizure have many forms, but all involve a change in the level of consciousness (see below). The area of seizure activity can be located using an EEG to map the electric signals in the brain. Seizures can also cause damage in the brain if they are frequent and severe. There are a number of medications and procedures that can be used to treat them, depending on the underlying cause.

Cerebral edema

Edema is the collecting of fluid, in this case fluid in and around the brain. Cerebral edema can happen in response to injury or infection. The brain only has so much room, so an excess of fluid can put pressure on it and impair its function. Excess fluid can be drawn away from the brain with medications like mannitol, or directly using a drain.

Hematomas

 

 

 

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A hematoma is a collection of blood at a site of injury. The most common hematoma is a bruise. Hematomas in and around the brain can cause a problem because of the limited space for the brain to swell, or for blood to pool. A hematoma can put pressure on the brain and affect function. Hematomas can sometimes be drained if they are on top of or in between the layers that surround the brain.

Hydrocephalus

Hydrocephalus is the collection of fluid in the ventricles of the brain. There are cells lining the ventricles where cerebral spinal fluid (CSF) is made. If the route for CSF circulation or drainage is blocked, hydrocephalus can result. This condition can lead to brain compression and increased pressure in the skull. Hydrocephalus can happen as a birth defect, injury, or disease. In the MSICU, new onset hydrocephalus is treated with an intraventricular drain placed into the ventricle. If the hydrocephalus becomes a chronic problem, the neurosurgeons will assess the need for a permanent drain called at VP Shunt.

Hemorrhages

An intracranial hemorrhage is a medical emergency. If a patient hemorrhages into the brain, a lot of damage can occur due to blood loss and increased pressure within the brain.

Subarachnoid hemorrhages

The brain and spinal cord are both surround by protective layers: the dura, arachnoid, and pia layers. The space between the arachnoid and pia layers is the largest, and is filled with fluid and arteries that supply the brain. Bleeding in this subarachnoid (below the arachnoid) space can be very dangerous because of all the arteries. Bleeding happens faster from arteries because they move blood at a higher pressure. Subarachnoid hemorrhages can be caused by head trauma, stroke, or an aneurysm that has burst.

Aneurysms

Aneurysms are arteries with weak walls. Arteries carry blood at high pressure. If they break open a lot of blood can escape very quickly. If they burst, they cause bleeding into the brain or the space around the brain. Subarachnoid hemorrhages are sometimes caused by ‘berry aneurysms’ that burst in the artery-rich subarachnoid space. Another common place for aneurysms is a circle of arteries around the bottom of the brain called the Circle of Willis. Aneurysms can indirectly cause a stroke if the artery that burst is the only one bringing blood to a certain part of the brain.

Strokes

A stroke is damage to part of the brain cause by a loss of blood supply. The blood supply may be cut off by a narrowed blood vessel or clot blocking the way, this is called an ischemic (is-keem-ic) stroke. When the blood supply is diminished by bleeding from another area of the brain, this is called a hemorrhagic stroke.

Decreased level of consciousness

 

 

 

 

 

 

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The patient’s level of consciousness can provide a lot of clues to how a person is doing. Consciousness can range from alert to comatose, but there are a lot of steps in between. If a patient’s level of consciousness starts to change, the team will assess the changes and implement a plan accordingly.

Changes in level of consciousness can be related to recent drugs administered, electrolyte imbalances, oxygen delivery and carbon dioxide exchange, etc. For example, a person may be given medications to reduce pain, limit anxiety, or help them sleep and these medications could make the patient more sleepy. Taking this into account, the level of consciousness is assessed regularly in the MSICU using the Glasgow Coma Scale and a Motor Activity Scale called VAMASS.

Delirium

Delirium is an altered level of consciousness that occurs frequently in intensive care. The MSICU is a very stressful environment, and the patient is experiencing a number of challenges to their body and mind. These stresses can cause a person to confuse reality and experience imagined events, have memory problems, and have problems paying attention or being aware of their surroundings. ICU delirium is caused by many factors, but factors common to intensive care are infection, sleep deprivation, disruption of the day and night cycles, the use of multiple medications, and stress to the body.

Delirium is managed by orienting the person to reality, helping them understand what is happening to them, and the use of specific drugs. At times, the use of sedatives and painkillers to help a patient rest can aggravate a patient’s delirium and the use of these drugs must be balanced with the need to prevent delirium.

Paralysis

Paralysis is the inability to feel or move certain parts of the body. Paralysis can be a result of an infection or injury. A person with a spinal cord injury may be paralyzed from the point of injury down. If they were hurt at the neck, they may not be able to move or feel anything below that point. Paralysis can also be induced with medications on purpose to allow for a procedure or operation. In these cases, the paralysis is temporary.

Trauma

Extensive injuries are referred to as trauma. Any head or spinal injury that causes a change in the level of consciousness or affects body function is a medical emergency. Head trauma may include a fractured skull, a broken neck, or crushing injuries. Although broken bones are a problem, the biggest concern with head trauma is the prevention, detection, and treatment of swelling that can compress the brain. The swelling from trauma may be blood (hematoma), fluid (cerebral edema), or tissues that have been pressed into the brain from injury.

Tumours

Tumours can affect the function of the brain in a couple of different ways. If the tumour is large enough, it can compress brain tissue and increase cranial pressure much like blood or fluid can. Certain kinds of tumours also prevent cells in the brain from doing what they are supposed to, disrupting thought, feeling, actions, and body functions.

Guillain-Barré syndrome (GBS)

This syndrome involves paralysis that starts in the legs and spreads up the body. Sometimes the paralysis goes high enough to affect a person’s breathing, making a ventilator necessary. After going so far up, the paralysis from GBS reverses itself from the top of the body back to the legs. Not all patients will recover back to their previous level of functioning prior to the onset of GBS. If your loved one has been diagnosed with GBS and is in the MSICU, please see the social worker for support with long term planning.

Coma

 

 

 

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A coma is a level of consciousness reduced to the point that a person is not aware of his or her surroundings. A person in a coma will not open their eyes to command, respond to pain, or speak. They can not be awoken. Most often, though, a coma is a result of brain injury or disease. Sometime the physician will use certain drugs to put a person in a coma if the body needs a rest and time to heal. These induced comas can be reversed when needed.

LHSCPatients, Families & Visitors

Last Updated August 18, 2008 | © 2007, LHSC, London Ontario Canada