Hannawi Yousef, Abers Michael S, Geocadin Romergryko G, Mirski Marek A
Neurosciences Critical Care Division, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA.
Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
Crit Care. 2016 Mar 14;20:60. doi: 10.1186/s13054-016-1236-2.
Abnormal movements are frequently encountered in patients with brain injury hospitalized in intensive care units (ICUs), yet characterization of these movements and their underlying pathophysiology is difficult due to the comatose or uncooperative state of the patient. In addition, the available diagnostic approaches are largely derived from outpatients with neurodegenerative or developmental disorders frequently encountered in the outpatient setting, thereby limiting the applicability to inpatients with acute brain injuries. Thus, we reviewed the available literature regarding abnormal movements encountered in acutely ill patients with brain injuries. We classified the brain injury into the following categories: anoxic, vascular, infectious, inflammatory, traumatic, toxic-metabolic, tumor-related and seizures. Then, we identified the abnormal movements seen in each category as well as their epidemiologic, semiologic and clinicopathologic correlates. We propose a practical paradigm that can be applied at the bedside for diagnosing abnormal movements in the ICU. This model seeks to classify observed abnormal movements in light of various patient-specific factors. It begins with classifying the patient's level of consciousness. Then, it integrates the frequency and type of each movement with the availability of ancillary diagnostic tests and the specific etiology of brain injury.
在重症监护病房（ICU）住院的脑损伤患者中经常会出现异常运动，然而，由于患者处于昏迷或不合作状态，对这些运动及其潜在病理生理学的特征描述很困难。此外，现有的诊断方法很大程度上源于门诊环境中常见的神经退行性或发育障碍的门诊患者，从而限制了其对急性脑损伤住院患者的适用性。因此，我们回顾了有关急性脑损伤患者中出现的异常运动的现有文献。我们将脑损伤分为以下几类：缺氧性、血管性、感染性、炎症性、创伤性、中毒代谢性、肿瘤相关性和癫痫发作。然后，我们确定了每类中出现的异常运动及其流行病学、症状学和临床病理相关性。我们提出了一种实用的范例，可在床边应用于诊断ICU中的异常运动。该模型旨在根据各种患者特定因素对观察到的异常运动进行分类。它首先对患者的意识水平进行分类。然后，它将每个运动的频率和类型与辅助诊断测试的可用性以及脑损伤的具体病因相结合。
