Brainstem dysfunction in critically ill patients.
Sarah BenghanemAurélien MazeraudEric AzabouVibol ChhorCassia Righy ShinotsukaJan ClaassenBenjamin RohautTarek SharsharPublished in: Critical care (London, England) (2020)
The brainstem conveys sensory and motor inputs between the spinal cord and the brain, and contains nuclei of the cranial nerves. It controls the sleep-wake cycle and vital functions via the ascending reticular activating system and the autonomic nuclei, respectively. Brainstem dysfunction may lead to sensory and motor deficits, cranial nerve palsies, impairment of consciousness, dysautonomia, and respiratory failure. The brainstem is prone to various primary and secondary insults, resulting in acute or chronic dysfunction. Of particular importance for characterizing brainstem dysfunction and identifying the underlying etiology are a detailed clinical examination, MRI, neurophysiologic tests such as brainstem auditory evoked potentials, and an analysis of the cerebrospinal fluid. Detection of brainstem dysfunction is challenging but of utmost importance in comatose and deeply sedated patients both to guide therapy and to support outcome prediction. In the present review, we summarize the neuroanatomy, clinical syndromes, and diagnostic techniques of critical illness-associated brainstem dysfunction for the critical care setting.
Keyphrases
- respiratory failure
- oxidative stress
- spinal cord
- cerebrospinal fluid
- magnetic resonance imaging
- end stage renal disease
- traumatic brain injury
- spinal cord injury
- liver failure
- newly diagnosed
- stem cells
- computed tomography
- blood pressure
- multiple sclerosis
- coronary artery
- white matter
- depressive symptoms
- prognostic factors
- bone marrow
- working memory
- pulmonary hypertension
- diffusion weighted imaging
- patient reported
- pulmonary arterial hypertension
- aortic dissection