Scott A. Marshall

A framework for diagnosing and classifying intensive care unit-acquired weakness

Neuromuscular dysfunction is prevalent in critically ill patients, is associated with worse short-term outcomes, and is a determinant of long-term disability in intensive care unit survivors. Diagnosis is made with the help of clinical, electrophysiological, and morphological observations; however, the lack of a consistent nomenclature remains a barrier to research. We propose a simple framework for diagnosing and classifying neuromuscular disorders acquired in critical illness.

The Role of Transcranial Doppler Ultrasonography in the Diagnosis and Management of Vasospasm After Aneurysmal Subarachnoid Hemorrhage

Transcranial Doppler ultrasonography (TCD) is a tool employed by the neurosurgeon and neurointensivist in the management of vasospasm in the intensive care unit after aneurysmal subarachnoid hemorrhage. A review of the current indications, monitoring parameters, indices, and relevance of modern TCD technology is provided, as well as algorithms for the use of TCD ultrasonography in the management of patients with subarachnoid hemorrhage. Other current uses of TCD ultrasonography are also discussed in the setting of neurocritical care.

Diagnosis and management of traumatic brain injury.

This article will provide an overview of the initial evaluation and management of traumatic brain injury (TBI). In cases of mild injury, conventional imaging in the absence of focal neurologic deficits is generally unrevealing. In the case of moderate or severe TBI, a review of neurocritical care is provided.

Cerebral Hemodynamic Changes After Wartime Traumatic Brain Injury

Traumatic brain injury (TBI) is associated with the severest casualties from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). From October 1, 2008, the U.S. Army Medical Department initiated a transcranial Doppler (TCD) ultrasound service for TBI; included patients were retrospectively evaluated for TCD-determined incidence of post-traumatic cerebral vasospasm and intracranial hypertension after wartime TBI. Ninety patients were investigated with daily TCD studies and a comprehensive TCD protocol, and published diagnostic criteria for vasospasm and increased intracranial pressure (ICP) were applied. TCD signs of mild, moderate, and severe vasospasms were observed in 37%, 22%, and 12% of patients, respectively. TCD signs of intracranial hypertension were recorded in 62.2%; 5 patients (4.5%) underwent transluminal angioplasty for post-traumatic clinical vasospasm treatment, and 16 (14.4%) had cranioplasty. These findings demonstrate that cerebral arterial spasm and intracranial hypertension are frequent and significant complications of combat TBI; therefore, daily TCD monitoring is recommended for their recognition and subsequent management.

Management of Moderate and Severe TBI

The management of moderate and severe traumatic brain injury (TBI) is a complex and developing practice in the acute neurosciences. The management of such, from the field phase of illness to the tertiary definitive medical and surgical management of TBI, is discussed. Clinical syndromes and radiographic examples of brain injury are presented, along with a current review of the literature in the early critical care phase of moderate and severe brain injury management. We discuss an algorithm for managing the challenging patient, and discuss areas of needed future research.