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Loop and Thiazide Diuretics

Objectives This chapter will: 1. Explain the mechanism of action of loop and thiazide diuretics. 2. Discuss pharmacokinetics and pharmacodynamics of loop and thiazide diuretics. 3. Discuss resistance to loop and thiazide diuretics. 4. Discuss the available evidence to guide the use of loop and thiazide diuretics in the acutely ill patient. 5. Discuss the adverse effects and toxicity of loop and thiazide diuretics. Acute kidney…

Blood Transfusion Therapy

Objectives This chapter will: 1. Review the transfusion indications for red blood cells, platelets, plasma, and cryoprecipitate in critically ill patients. 2. Outline the principles of massive transfusion. 3. Discuss common transfusion reactions and their management. Over the last two decades, multiple randomized controlled trials (RCTs) have been conducted to evaluate clinical effects of transfusion in various patient populations. Information gleaned from these clinical trials formed…

Principles of Fluid Therapy

Objectives This chapter will: 1. Describe the physiologic rationale for fluid resuscitation in the intensive care unit. 2. Discuss choice of fluid, volume, and end points for intravenous fluid resuscitation. Administering intravenous (IV) fluid is one of the most common interventions in the intensive care unit (ICU). Although IV fluid can be used to replace free water, electrolytes, glucose, and plasma constituents (e.g., albumin), most IV…

Radiologic Features of Central Nervous System Tumors

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 144.1 . Key Concepts MRI is the primary imaging modality for brain tumor detection and characterization. CT is a useful imaging modality to evaluate bone involvement of extra-axial tumors. Advanced MRI techniques can help differentiate between tumor types and help noninvasively determine prognosis and tumor grade. Advanced positron emission tomography (PET)…

Clinical Features: Neurology of Brain Tumor and Paraneoplastic Disorders

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 143.1 . Key Concepts The neurological complications of cancer include headaches, seizures, focal neurological symptoms, and cognitive and behavioral changes. Paraneoplastic neurological syndromes may precede the cancer diagnosis, and therefore it is crucial to identify these syndromes in a timely manner and screen regularly for malignancy. Basis for Neurological Dysfunction in…

Epidemiology of Brain Tumors

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 142.1 . Key Concepts Risks of gliomas and meningiomas vary significantly across sex, age, histology, ethnicity, and geography. The incidences of glioblastoma (the most common type of glioma) and meningioma increase with age. Gliomas are more common in males across all age groups and histologies and have the highest incidence in…

Delivery of Therapy to Brain Tumors: Problems and Potentials

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 141.1 . Key Concepts A combination of tight junctions and neighboring astrocytes in the blood-brain barrier (BBB) creates a significant obstacle in the effective delivery of chemotherapeutics to brain tumors. Modification of drugs into lipophilic analogues or in conjunction with lipophilic carriers can potentiate passive diffusion through the BBB, but high…

Angiogenesis and Brain Tumors: Scientific Principles, Current Therapy, and Future Directions

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 140.1 . This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 140.1 . Key Concepts Anti–vascular endothelial growth factor (VEGF) therapy (bevacizumab [Avastin]) has been approved by the US Food and Drug Administration (FDA) for the treatment of recurrent glioblastoma and is useful to pharmacologically…

Basic Science of Brain Metastases

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 139.1 . Key Concepts Melanomas and lung, breast, colorectal, and renal cancers show the most proclivity for the brain, followed more uncommonly by thyroid, gastrointestinal (GI), and prostate cancers. Lung cancer is the primary tumor in about 40% to 50% of patients diagnosed with brain metastases (BMs). Breast cancer is unique…

Malignant Glioma Microenvironment

Key Concepts The malignant glioma microenvironment is infiltrated by multiple types of immune cells, including myeloid cells and microglia, which are a significant component of these tumors. These cells contribute to immunosuppression and facilitate tumor cell invasion of normal brain. Targeting these cells has become an important therapeutic concept. Extracellular matrix (ECM) in malignant gliomas has a unique composition that enables tumor growth and survival. Interactions…

The Genetic Origins of Brain Cancers

This chapter includes an accompanying lecture presentation that has been prepared by the author: Video 137.1 . Key Concepts The basis of CNS malignancies is DNA mutations in genes that regulate cell fate, survival, and genome maintenance. Most commonly these mutations arise by errors in DNA replication, but initiating mutations can be inherited as a mendelian cancer syndrome. Approximately two to seven mutations are required for…

Molecular Genetics and the Development of Targets for Glioma Therapy

Acknowledgment We sincerely thank Dr. Ali Ravanpay for his work on the previous edition of this chapter, which was critical for the updates provided in this new version. This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 136.1 . Key Concepts IDH1 mutations significantly influence the survival of patients with gliomas. Single-cell RNA sequencing demonstrates significant intratumoral heterogeneity within glioblastomas.…

Brain Tumor Stem Cells

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 135.1 . Key Concepts Glioblastoma multiforme cells are hierarchically organized with brain tumor stem cells (BTSCs) on top. BTSCs have stem cell properties and are tumorigenic. BTSCs may arise from cells of the subventricular zone (SVZ). A single comprehensive BTSC marker remains to be identified. Several pathways are involved in stem…

Brain Tumor Immunology and Immunotherapy

Acknowledgments We would like to thank Gena S. Behnke for her expertise and graphic design skills for assistance in constructing the figures for this work. This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 134.1 . Key Concepts The CNS is immunocompetent with lymphatic vessels that drain to cervical lymph nodes, allowing for sampling of the CNS with peripheral immune…

Brain Tumors: An Overview of Current Histopathologic and Genetic Classifications

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 133.1 . Key Concepts In adults, meningioma is the most common benign brain tumor and glioblastoma is the most common malignant brain tumor. The most important prognostic factor in patients with infiltrating gliomas (astrocytoma, oligodendroglioma, and glioblastoma) is the presence or absence of an IDH1 or IDH2 mutation. Combined IDH1 /…

Neuroprosthetics

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 132.1 . Key Concepts A neuroprosthetic is a device that supplants or supplements the input or output of the nervous system. The clinical goal of a neuroprosthetic is to restore lost function or augment existing abilities. The interface a neuroprosthetic uses to link a human with a machine is variable. Research…

Deep Brain Stimulation for Alzheimer Disease

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 131.1 . Key Concepts Alzheimer dementia is the most common form of dementia worldwide and is showing a steadily growing incidence, especially in developed countries. Medical therapy is limited, and new treatment modalities are needed. In a case report, chronic deep brain stimulation (DBS) of the fornix led to improvement in…

Deep Brain Stimulation for Obesity

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 130.1 . Key Concepts Morbid obesity is a worldwide crisis with few successful treatment strategies. Obesity is the result of a complex interplay among genetic, homeostatic, hedonic, and environmental factors, with several central nervous system pathways and mechanisms involved. Several targets, including the lateral hypothalamus, ventromedial hypothalamus, and nucleus accumbens have…

Motor Cortex Stimulation for Pain and Movement Disorders

This chapter includes an accompanying slide presentation that has been prepared by the authors: Video 129.1 . Key Concepts In performing motor cortex stimulation (MCS), the use of intraoperative neurophysiologic confirmation is critical for the success of the procedure. MCS tends to work best in patients with poststroke thalamic pain and those with atypical facial pain. The use of the intraoperative neurophysiologic data is important in…

Treatment of Intractable Vertigo

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 128.1 . Key Concepts Vertigo can be divided into peripheral causes (involving the vestibular nerve and labyrinth) and central causes (involving the brainstem and cerebellum). Central vestibular disorders include vertebrobasilar insufficiency, migrainous vertigo, tumors, paraneoplastic syndromes, and demyelinating disorders. Peripheral causes include benign paroxysmal positional vertigo (BPPV), Meniere disease, labyrinthitis, vestibular…