Acute ischaemic stroke is associated with a high risk of non-neurological complications, which include respiratory failure, cardiovascular dysfunction, kidney and liver injury, and altered immune and endocrine function. The aim of this manuscript is to provide an overview of the main forms of stroke-induced distal organ damage, providing new pathophysiological insights and recommendations for clinical management. Non-neurological complications of stroke can affect outcomes, with potential for serious short-term and long-term consequences. Many of these complications can be prevented; when prevention is not feasible, early detection and proper management can still be effective in mitigating their adverse impact. The general care of stroke survivors entails not only treatment in the acute setting but also prevention of secondary complications that might hinder functional recovery. Acute ischaemic stroke triggers a cascade of events—including local and systemic activation of the immune system—which results in a number of systemic consequences and, ultimately, may cause organ failure. Understanding the pathophysiology and clinical relevance of non-neurological complications is a crucial component in the proper treatment of patients with acute stroke. Little evidence-based data is available to guide management of these complications. There is a clear need for improved surveillance and specific interventions for the prevention, early diagnosis, and proper management of non-neurological complications during the acute phase of ischaemic stroke, which should reduce morbidity and mortality.

/pdf/ischaemic-stroke-induced-distal-organ-damage-pathophysiology-3nw41bsudd.pdf

Ischaemic stroke-induced distal organ damage: pathophysiology and new therapeutic strategies.

Gastrointestinal (GI) dysfunction is common in the critical care setting and is highly associated with clinical outcomes. Opioids increase the risk for GI dysfunction and are frequently prescribed to reduce pain in critically ill patients. However, the role of opioids in GI function remains uncertain in the ICU. This review aims to describe the effect of opioids on GI motility, their potential risk of increasing infection and the treatment of GI dysmotility with opioid antagonists in the ICU setting.

/pdf/the-effect-of-opioids-on-gastrointestinal-function-in-the-4st24yylzz.pdf

The effect of opioids on gastrointestinal function in the ICU.

Endogenous opiates and behavior: 2020

Crosstalk between various organs exists in the human body. This can be part of physiological reflexes such as cardiac reflexes that protect the organs during stressful stimuli or can be part of pathological conditions where an insult to an organ releases cytokines that cause distant effects on other organs. In critically ill patients, these crosstalks are independent of pre-existing common risk factors or the presence of new risk exposure during the treatment. Crosstalk can manifest in series or parallel. The human brain, being a control center of the human body, does crosstalk with almost every organ in the body. In this narrative review, crosstalk of the brain with various organs and systems such as the heart, lungs, liver, kidneys, gut, muscle, bone, skin, adipose tissue, and immune system is being discussed along with clinical manifestations and management. Future research might help to target these pathological processes in preventing progression of single-organ dysfunction to multi-organ failures in critically ill patients.

/pdf/brain-crosstalk-with-other-organs-in-icu-patient-ajetki0q6y.pdf

Brain Crosstalk with Other Organs in ICU Patient

Aneurysmal subarachnoid hemorrhage is a life-threatening event that can cause permanent disability. This life-threatening event can be further complicated by subsequent cardiac and pulmonary disability. The presence of a neurogenic cardiomyopathy and pulmonary edema increases the morbidity and mortality of patients who suffer from aneurysmal subarachnoid hemorrhage.  In this paper, we discuss a 39-year-old woman who presented to the emergency department (ED) with a chief complaint of a pounding headache with associated nausea and vomiting for the past three days. She had a past medical history significant only for migraines. During her stay in the ED, she began to exhibit signs of altered consciousness, hemoptysis, and respiratory compromise. Neuroimaging showed evidence of subarachnoid hemorrhage. The exact source of her subarachnoid hemorrhage could not be located with neuroimaging or angiography. Her clinical course was complicated by pulmonary edema and neurogenic stunned myocardium, and is still ongoing.

https://scholarlycommons.baptisthealth.net/cgi/viewcontent.cgi?article=4785&context=se-all-publications

Pulmonary Edema and Stunned Myocardium in Subarachnoid Hemorrhage.

Opioid antagonists in the ICU are often a last-line medication given to patients with opioid-induced constipation. Traditionally, patients have been administered nonopioid-based bowel regimens such as senna, peg, and docusate to treat constipation. Despite the obvious need to treat acute pain with opioids, side effects such as constipation can lead to multiple gastrointestinal (GI) complications such as bowel perforation and even death. Specifically, opioid-induced constipation (OIC) can be very difficult to treat. We examine naloxone and methylnaltrexone (MNTX) assessing GI complications and OIC as well as present a patient case which highlights the importance of treating OIC. We also evaluate the superior reversal agent of choice when treating OIC in the critical care and stepdown unit settings.

Methylnaltrexone and Naloxone for Opioid-induced Constipation in the Critical Care Setting.

Neurogenic stunned myocardium (NSM) is defined as the occurrence of cardiac abnormalities due to neurological events such as stroke, seizures, etc. These events lead to dysfunction of the autonomic nervous system (ANS) and ultimately cause injury to the myocardium. The clinical features seen in NSM include elevated troponin level, left ventricular dysfunction, and changes on the electrocardiogram (ECG). However, these features are also seen in Takotsubo cardiomyopathy as well as in an acute coronary syndrome (ACS). Hence, diagnosing the condition by clinical presentation alone is difficult. Thus, a patient of NSM who is at increased risk of developing coronary heart disease may require invasive procedures such as cardiac catheterization to rule out ACS. This review aims at raising awareness about NSM among physicians so that management of patients can be individualized.

Neurogenic Stunned Myocardium: A Literature Review.

Retraction: Neurogenic Stunned Myocardium: A Literature Review.

IgG4-related lung disease is an extremely rare and novel entity which is still poorly understood. We reviewed the 16 patients diagnosed with IgG4-related disease from October 2014 through December 2019 at our institution. The three cases that showed pulmonary involvement are included in this series. Of these, two patients had cavitary lung disease and developed aspergilloma and chronic cavitating aspergillosis after a prolonged course of steroid therapy, and one had isolated pulmonary nodule and ground glass opacity. We reviewed the updated literature and briefly described disease epidemiology, clinical characteristics, diagnostic approaches, and management strategies for IgG4-related lung disease.

IgG4 related lung disease- a rare and novel mimic of malignancy and infections-a case series of three patients with a brief review of updated literature.

Zara Alvi

Papers

Methylnaltrexone and Naloxone for Opioid-induced Constipation in the Critical Care Setting.

Neurogenic Stunned Myocardium: A Literature Review.

Retraction: Neurogenic Stunned Myocardium: A Literature Review.

IgG4 related lung disease- a rare and novel mimic of malignancy and infections-a case series of three patients with a brief review of updated literature.