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Acute encephalitis although a rare syndrome in absolute numbers is a common differential diagnosis for unexplained encephalopathy in patients presenting to both neurological and general intensive care units. This talk will review management of the critically ill patient with suspected encephalitis. The broad differential diagnosis will be considered and diagnostic approaches to seek both infectious and immune-mediated causes for encephalitis discussed. The importance of antibody-mediated forms of encephalitis and differences in aetiologies of infectious encephalitis relating to geography will be emphasised. Both antimicrobial and immunomodulatory treatments for encephalitis will be reviewed. The importance of control of seizures and management of intracranial pressure will be outlined. The audience will be directed to guidelines from specialist societies for reference.

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Epilepsy is relevant in the Intensive Care Unit (ICU), either because someone is transferred into ICU because of their seizures (usually status epilepticus) or they develop seizures/status epilepticus whilst in the ICU. The main challenge in the latter situation is the diagnosis of the seizures (many of which are non-convulsive). Indeed, it has been estimated that 8% of people in ICU in coma with no clinical signs of seizure activity are in electrographic status epilepticus, indicating the important role that EEG can play in the management of coma. However, even with EEG, it is important to differentiate seizure activity from interictal activity or EEG signatures of encephalopathies/cerebral damage. The detection and diagnosis of seizures in people in coma depends upon strict EEG criteria and the length of the EEG recordings. There have been no treatment trials in this population, and the prognosis of status epilepticus in coma is usually poor.

In people transferred to ICU in status epilepticus, aetiology is key to determining prognosis and appropriate treatments. The identification of autoimmune and inflammatory aetiologies has transformed treatment protocols and approaches. In addition, there have been multiple new antiseizure medications and novel brain simulation therapies. Despite, these advances, the prognosis of super-refractory status epilepticus (status epilepticus that continues for 24 hours or more after the use of anaesthetic therapy), remains poor and the use of prolonged anaesthesia in such patients has significant associated morbidities. However, preclinical work has indicated other potential treatments approaches that may offer significant benefits.

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THE ROLE OF ICP IN TRAUMATIC BRAIN INJURY

Traumatic brain injury is a major problem in the current life style including motor vehicle accidents, fall from height, industrial injuries & assault cases.

The current treatment of severe traumatic brain injury (GCS < 8) will include intubation, assisted ventilation, removal of intracranial hematomas, decompression craniotomy & all these interventions are assisted & guided by proper intra cranial pressure monitoring.

The types & the role of ICP in management of traumatic brain injury will be discussed in addition to the most up to date research on the topic will be discussed in my presentation.

Imad Hashim Ahmad Al Anoo