Diagnostics of Central and Autonomic Nervous System Dysfunction in Patients with Sepsis-Associated Encephalopathy

This chapter is devoted to monitoring of central and autonomic nervous system (ANS) in patients with verified sepsis to recognize the specific functional and anatomic changes in the brain and its important autonomic centers which is named sepsis-associated encephalopathy (SAE). Fluctuation of conscience level from agitation to delirium and coma, muscle tone, and severity of pain syndrome is evaluated with different scales (SOFA, SAPS II, RASS, CAM-ICU, FOUR, PBSS, BPS, MRC, MAS, CNS). Multimodal neuromonitoring includes EEG, EPs, ENMG, cerebral oxymetry, saturation in the bulb of the jugular vein, TCD, and neuroimaging (MRI, PET). Dysfunction of autonomic brainstem structures is detected with variational cardiointervalometry, pupillometry, thermometry (peripheral and central), photoplethysmography assessment of perfusion index, quantitative assessment of muscle strength on the MRC scale and MAS, and diagnostics of the severity of the PSH syndrome. Monitoring data help clinicians to make decisions on SAE patient management tactics

CSF Bypass Surgery in Children with Hydrocephalus: Modern Possibilities, Prospects and Ways of Solving the Correction of Complications

The chapter discusses modern and promising approaches to the use of CSF shunting operations in children. CSF shunting operations remain the only effective method for correcting persistent CSF circulation disorders in CSF resorption disorders with the development of intracranial hypertension and hydrocephalus. The chapter is devoted to general ideas about CSF dynamics and biomechanical properties of the craniospinal system that affect CSF dynamics, and gives a pathogenetic assessment of CSF dynamics in the development of intracranial hypertension and hydrocephalus. Aspects of genetics and genomics of anomalies in hydrocephalus are touched upon. Pathological changes in the brain around old ventricular shunts are described. The authors consider the types of CSF shunting operations for hydrocephalus in children. Possible complications of CSF shunting operations are analyzed with the algorithm for their correction and management tactics for this group of patients