The COmatose Patient (2nd ed.)Canonical Reading Material for the Exam Candidate

The unavoidable reading material for this topic includes the following textbook chapters and papers:

Oh's Intensive Care manual:

  • Chapter 49   (pp. 549) Disorders  of  consciousness  by Balasubramanian  Venkatesh
  • Chapter 50   (pp. 560) Status  epilepticus  by Helen  I  Opdam
  • Chapter 51   (pp. 568)  Acute  cerebrovascular  complications by Bernard  Riley  and  Thearina  de  Beer
  • Chapter 52   (pp. 580)  Cerebral  protection by Victoria  Heaviside  and  Michelle  Hayes
  • Chapter 53  (pp. 591)  Brain  death by Martin  Smith
  • Chapter 57  (pp. 617)  Neuromuscular diseases in intensive care by George  Skowronski and Manoj K  Saxena
  • Chapter 78 (pp. 795) Spinal injuries by Sumesh Arora and Oliver J Flower

Reading the  Brain Trauma Foundation guidelines is also unavoidable.

Walker and O'Brien's 1990 paper "Neurological examination of the unconscious patient" is an excellent brief synopsis; it draws its inspiration from the 1980 edition of Plum and Posner's "The Diagnosis of Stupor and Coma", which is essentially the Old Testament for neurological examination of the critically ill. The time-poor candidate will probably be unable to make use of this textbook, but the paper needs to be read through at least once before the exam. The hypothetical exam candidate with infinite time resources may also benefit from exploring The Comatose Patient by Eelco Wijdicks (2014).

Summaries and discussions of neurological and neurosurgical topics from Life in the Fast Lane are made available as a list of links in the Resources section.
Intracranial Pressure and Cerebral Perfusion
Methods of intracranial pressure monitoring
Indications for intracranial pressure monitoring
Cerebral metabolic demand
Cerebral bloodflow autoregulation
Interpretation of intracranial pressure waveforms
Correlation of ICP waveforms with intracranial pathology
Traumatic Brain Injury
A summary of the Brain Trauma Foundation guidelines
Prevention of secondary brain injury: "Neuroprotective Measures"
Management of raised intracranial pressure
Osmotherapy for management of raised intracranial pressure
Intracranial pressure as a therapeutic target
Cerebral perfusion pressure as a therapeutic target
Post-traumatic seizures, their prevention and management
Prognosis in severe brain injury
Brain herniation
Decompressive craniectomy for traumatic brain injury
Therapeutic and prophylactic hypothermia for traumatic brain injury
Limitations of CT in assessment of traumatic brain injury
Polyuria following traumatic brain injury
Cerebral salt wasting syndrome
Concussion and unconsciousness following head injury
Haemodialysis in patients with traumatic brain injury
Ischaemic and Haemorrhagic Stroke
Causes and classifications of stroke
Classical stroke syndromes
Acute supportive management for stroke in the ICU
Decompressive craniectomy for malignant MCA infarction
Arguments against ICU admission for comatose stroke patients
Definitive management options for early ischaemic stroke
Factors which influence prognosis of intracranial haemorrhage
Cerebral venous sinus thrombosis
Subarachnoid Haemorrhage
Risk factors for subarachnoid haemorrhage
Grading of subarachnoid haemorrhage severity
Monitoring for vasospasm following SAH
Prevention and management of vasospasm following SAH
Evidence for the use of nimodipine in SAH
Non-vasospasm complications of SAH
Management of the unsecured aneurysm in subarachnoid haemorrhage
Approach to the Patient with Weakness
Sustained neuromuscular junction blockade in critical illness
Approach to the ICU patient with generalised weakness
Features that distinguish myopathy from neuropathy
Intensive Care for Guillain-Barre Syndrome
Critical illness polyneuromyopathy
Distinguishing features of Guillain-Barre syndrome
Spinal Injury and Lesions of the Peripheral Nervous System
Physiological consequences of spinal cord transection
Management of acute high spinal injury
Clearance of the C-spine in the unconscious patient
Important spinal cord injury syndromes
Eponymous spinal fractures
The dermatomes
Brachial plexus: anatomical course and lesions
Ulnar nerve: anatomical course and lesions
Median nerve: anatomical course and lesions
Radial nerve: anatomical course and lesions
Status Epilepticus and Management of Seizures
Management of Status Epilepticus in ICU
Non-convulsive status epilepticus
Relationship of seizure duration and neurological outcome
Extracranial consequences of status epilepticus
Causes of status epilepticus
Features that discriminate "true" seizures from pseudoseizures
Neurological Examination and Investigations
The Glasgow Coma Scale in the assessment of consciousness
Approach to the unconscious patient in the ICU
States of persistent unconsciousness
Causes of neck stiffness
Assessment of swallowing function in a critically ill patient
Physical signs of cerebellar disease
Properties and contents of cerebrospinal fluid
The utility of the EEG in the ICU
The utility of SSEPs in the ICU
Cranial Nerve Examination in the Critically Ill Patient
Examination of the cranial nerves
Examination and lesions of the olfactory nerve (CN I)
Examination of visual acuity and blindness (CN II)
Fundoscopy: characteristic findings (CN II)
Examination of pupil reactivity and diameter (CN II, III)
Visual fields and lesions of the visual pathways (CN II)
Examination of eye movements (CN III, IV, VI)
Lesions of the oculomotor nerve (CN III)
Lesions of the trochlear nerve (CN IV)
Lesions of the abducens nerve (CN VI)
Disorders of conjugate gaze
Lesions of the trigeminal nerve (CN V)
Lesions of the facial nerve (CN VII)
Corneal reflex (CN V, VII)
Oculocephalic and cold caloric reflexes (CN III, IV, VI and VIII)
Lesions of the vestibulocochlear nerve (CN VIII)
Lesions of the glossopharyngeal and vagus nerves (CN IX and X)
Lesions of the accessory nerve (CN XI)
Lesions of the hypoglossal nerve (CN XII)
Horner's Syndrome
Neuromiscellanea
The Significance of Hiccups
Thromboprophylaxis in neurosurgical patients
Posterior reversible leukoencephalopathy syndrome (PRES)
Pneumocephalus