Article Text

Download PDFPDF
Neurological consultations in the medical intensive care unit
  1. Saif S M Razvi,
  2. Ian Bone
  1. Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK
  1. Correspondence to:
 Professor Ian Bone, Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, 1345 Govan Road, Glasgow G51 4TF, UK; 

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Critical care therapy has advanced over the past two decades, treating more patients and providing more complex care. However, the improved survival from septic shock, adult respiratory distress syndrome (ARDS), and multiple organ system failure results in critically ill patients facing a spectrum of new complications secondary to both illness and treatment. A third of intensive care unit (ICU) admissions have a neurological complication detrimental to outcome.1 Neurological status (mainly depressed consciousness) is the major contributor to prolonged ventilation in a third of those who need it and is a significant factor in an additional 40%. Neurological complications double both the length of stay in hospital and the likelihood of death; the mortality rate for patients with neurological complications is 55% compared to 29% for those without. It is therefore unsurprising that neurologists are being increasingly called upon to review patients on the medical intensive care unit (MICU).

A neurological opinion is usually requested:

  • to assess neurological manifestations of the primary disease process

  • to evaluate the consequences of critical care therapy

  • to offer a prognosis, or

  • determine brain death.

The neurologist must approach these complex patients in a logical, meticulous, and sensitive manner. There are obvious inherent difficulties in reviewing on the MICU:

  • difficulties in communication (sedation/endotracheal tube)

  • bulky case records and numerous investigation results (scans often “off-site”)

  • a “Pandora’s box” of ICU terminology (ARDS, SIRS, MODS, etc)

  • unfamiliarity with types and levels of respiratory support, anaesthetic agents, and neuromuscular blockade

  • limitations of the clinical examination caused by sedation or neuromuscular blockade

  • constraints in arranging further investigations (for example, availability of neurophysiology or ventilator/magnetic resonance imaging (MRI) compatibility)


The terminologies used on the ICU are formidable and often ill understood by the consulting clinician. Knowledge of the taxonomy of sepsis and allied syndromes is essential in appreciating their neurological …

View Full Text