Key Contacts

Specific to TWH MSNICU

These resources are specific to clinical situations you may encounter in the TWH MSNICU.  They are intended for ICU fellows or residents with substantial previous ICU exposure. For residents new to the ICU, we recommend focusing your learning on the general ICU concepts above.

We care for a large number of critically ill patients with acute and complex neurological problems in the TWH MSNICU: strokes, intracerebral hemorrhage and subarachnoid hemorrhage, status epilepticus and acute spinal cord injuries.  Determination of death by neurological criteria and management of the organ donor is also a focus of local expertise and you may gain exposure to these unique patients in the MSNICU. 

Seizures and Status Epilepticus

Seizures:

  1. TWH / Krembil Brian Institute Seizure Management Protocol
  2. Management of Established SE (NEJM Review 2019)
  3. Krembil Brain Institute MSNICU Acute Seizure Algorithm (v7)
  4. New Onset Refractory Status Epilepticus (StatPearls)
  5. A practical approach to in-hospital management of NORSE/FIRES (Frontiers Review 2023)

NMDA-Receptor and Other Encephalitides:

  1. An update on anti-NMDA receptor encephalitis (Dalmau  Lancet Neurology 2019)
  2. Antibody-Medical Encephalitis (Dalmau NEJM 2018)
  3. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis

Continual EEG and Inter-ictal Continuum:

  1.  Continuous vs Routine Electroencephalogram in Critically Ill Adults With Altered Consciousness and No Recent Seizure(JAMA 2020)
  2. Treatment of Interictal Continuum (StatPearls)

Key Studies and RCTs on Seizure Management:

  1. ESETT (NEJM 2019)
  2. RAMPART(NEJM 2012)

Intracerebral Hemorrhage

Here are some useful resources about intracerebral hemorrhage

General Review / Guidelines:

Blood Pressure Control:

Surgical Intervention 

  • Early Minimally-Invasive Removal of Intracerebral Hemorrhage – ENRICH
  • Decompressive Craniectomy + Best Medical Management – SWITCH

Aneurysmal Subarachnoid Hemorrhage

Here are some useful resources about aneurysmal subarachnoid hemorrhage

General Review / Guidelines:

Delayed Cerebral Ischemia / Vasospasm

Death Determination by Neurologic Criteria and Organ Donor Management

Death Determination by Neurologic Criteria:

Management of the Potential Organ Donor

Intracranial Pressure

Here are some useful resources about intracranial pressure monitoring and cerebrovascular physiology:

ICP Monitoring and Management of Raised ICP

  1. Intracranial Pressure – Basics Part One 
  2. Intracranial Pressure – Basics Part Two
  3. A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC)
  4. Monitoring and interpretation of intracranial pressure

Cerebrovascular Physiology:

  1. Cerebral Blood Flow and Stroke