Neurological Intensive Care Patients Research Articles

Cerebrospinal Fluid and Arterial Acid–Base Equilibrium of Spontaneously Breathing Patients with Aneurismal Subarachnoid Hemorrhage

BackgroundHyperventilation resulting in hypocapnic alkalosis (HA) is frequently encountered in spontaneously breathing patients with acute cerebrovascular conditions. The underlying mechanisms of this respiratory response have not been fully elucidated. The present study describes, applying the physical–chemical approach, the acid-base characteristics of cerebrospinal fluid (CSF) and arterial plasma of spontaneously breathing patients with aneurismal subarachnoid hemorrhage (SAH) and compares these results with those of control patients. Moreover, it investigates the pathophysiologic mechanisms leading to HA in SAH.MethodsPatients with SAH admitted to the neurological intensive care unit and patients (American Society of Anesthesiologists physical status of 1 and 2) undergoing elective surgery under spinal anesthesia were enrolled. CSF and arterial samples were collected simultaneously. Electrolytes, strong ion difference (SID), partial pressure of carbon dioxide (PCO2), weak noncarbonic acids (ATOT), and pH were measured in CSF and arterial blood samples.ResultsTwenty spontaneously breathing patients with SAH and 25 controls were enrolled. The CSF of patients with SAH, as compared with controls, was characterized by a lower SID (23.1 ± 2.3 vs. 26.5 ± 1.4 mmol/L, p < 0.001) and PCO2 (40 ± 4 vs. 46 ± 3 mm Hg, p < 0.001), whereas no differences in ATOT (1.2 ± 0.5 vs. 1.2 ± 0.2 mmol/L, p = 0.95) and pH (7.34 ± 0.06 vs. 7.35 ± 0.02, p = 0.69) were observed. The reduced CSF SID was mainly caused by a higher lactate concentration (3.3 ± 1.3 vs. 1.4 ± 0.2 mmol/L, p < 0.001). A linear association (r = 0.71, p < 0.001) was found between CSF SID and arterial PCO2. A higher proportion of patients with SAH were characterized by arterial HA, as compared with controls (40 vs. 4%, p = 0.003). A reduced CSF-to-plasma difference in PCO2 was observed in nonhyperventilating patients with SAH (0.4 ± 3.8 vs. 7.8 ± 3.7 mm Hg, p < 0.001).ConclusionsPatients with SAH have a reduction of CSF SID due to an increased lactate concentration. The resulting localized acidifying effect is compensated by CSF hypocapnia, yielding normal CSF pH values and resulting in a higher incidence of arterial HA.

Evaluation of a new wireless technique for continuous electroencephalography monitoring in neurological intensive care patients.

A novel wireless eight-channel electroencephalography (EEG) headset specially developed for ICUs was tested in regard of comparability with standard 10/20 EEG systems. The continuous EEG (cEEG) derivations via CerebAir EEG headset (Nihon Kohden Europe, Rosbach, Germany) and internationally standardized 10/20 reference EEGs as the diagnostic standard were performed in a mixed collective on a neurointensive care unit (neuro-ICU). The derivations were verified for comparability in detection of EEG background activity, epileptiform discharges, and seizure patterns. Fifty-two patients with vigilance reduction following serious neurological or metabolic diseases were included, and both methods were applied and further analyzed in 47. EEG background activity matched in 24 of 45 patients (53%; p = 0.126), epileptiform discharges matched in 32 (68%) patients (p = 0.162), and seizure activity matched in 98%. Overall, in 89% of the patients, cEEG detected the same or additional ICU-relevant EEG patterns. The tested wireless cEEG headset is a useful monitoring tool in patients with consciousness disorders. The present study indicates that long-term measurements with the wireless eight-channel cEEG lead to a higher seizure and epileptiform discharge detection compared to intermittent 10/20 EEG derivations in the ICU setting.

Flexible endoscopic evaluation of swallowing (FEES) to determine neurological intensive care patients’ oral diet

Purpose Dysphagia is common in critically ill neurological patients and is associated with a high mortality and morbidity. Data on the usefulness of flexible endoscopic examination of swallowing (FEES) in neurological intensive care unit (ICU) patients are lacking, raising the need for evaluation. Method FEES was performed in neurological intensive care patients suspected of dysphagia. We correlated findings with baseline data, disability status, pneumonia and duration of hospitalisation, as well as a need for mechanical ventilation or tracheotomy. Result This analysis consisted of 125 patients with suspected dysphagia. Most of the patients (81; 64,8%) suffered from acute stroke. Dysphagia was diagnosed using FEES in 90 patients (72%). FEES results led to dietary modifications in 80 patients (64%). The outcome at discharge was worse in dysphagic stroke patients diagnosed by FEES as compared to non-dysphagic stroke patients (p = 0.009). Patients without oral diet had higher need for intubation (p = 0.007), tracheotomy (p = 0.032) and higher mortality (p < 0.001) in comparison to patients with at least small amounts of oral intake. Conclusion As the clinical assessment of the patients often classified the dysphagia incorrectly, the broad use of FEES in ICU patients might help to adequately adjust patients’ oral diet. This knowledge might contribute to lower mortality and morbidity.

Prediction of rhythmic and periodic EEG patterns and seizures on continuous EEG with early epileptiform discharges.

Continuous EEG (cEEG) is necessary to document nonconvulsive seizures (NCS), nonconvulsive status epilepticus (NCSE), as well as rhythmic and periodic EEG patterns of 'ictal-interictal uncertainty' (RPPIIU) including periodic discharges, rhythmic delta activity, and spike-and-wave complexes in neurological intensive care patients. However, cEEG is associated with significant recording and analysis efforts. Therefore, predictors from short-term routine EEG with a reasonably high yield are urgently needed in order to select patients for evaluation with cEEG. The aim of this study was to assess the prognostic significance of early epileptiform discharges (i.e., within the first 30 min of EEG recording) on the following: (1) incidence of ictal EEG patterns and RPPIIU on subsequent cEEG, (2) occurrence of acute convulsive seizures during the ICU stay, and (3) functional outcome after 6 months of follow-up. We conducted a separate analysis of the first 30 min and the remaining segments of prospective cEEG recordings according to the ACNS Standardized Critical Care EEG Terminology as well as NCS criteria and review of clinical data of 32 neurological critical care patients. In 17 patients with epileptiform discharges within the first 30 min of EEG (group 1), electrographic seizures were observed in 23.5% (n = 4), rhythmic or periodic EEG patterns of 'ictal-interictal uncertainty' in 64.7% (n = 11), and neither electrographic seizures nor RPPIIU in 11.8% (n = 2). In 15 patients with no epileptiform discharges in the first 30 min of EEG (group 2), no electrographic seizures were recorded on subsequent cEEG, RPPIIU were seen in 26.7% (n = 4), and neither electrographic seizures nor RPPIIU in 73.3% (n = 11). The incidence of EEG patterns on cEEG was significantly different between the two groups (p = 0.008). Patients with early epileptiform discharges developed acute seizures more frequently than patients without early epileptiform discharges (p = 0.009). Finally, functional outcome six months after discharge was significantly worse in patients with early epileptiform discharges (p=0.01). Epileptiform discharges within the first 30 min of EEG recording are predictive for the occurrence of ictal EEG patterns and for RPPIIU on subsequent cEEG, for acute convulsive seizures during the ICU stay, and for a worse functional outcome after 6 months of follow-up. This article is part of a Special Issue entitled Status Epilepticus.

Use of a cyanoacrylate skin adhesive to reduce external ventricular drain infection rates

OBJECT.: Ventriculitis related to external ventricular drain (EVD) placement is a significant source of morbidity in neurological intensive care patients. Current rates of EVD-related infections range from 2% to 45% in the literature. The authors sought to determine if a 2-octyl cyanoacrylate adhesive would result in lower infection rate than standard semiocclusive dressings. The authors tracked ventriculitis rates via CSF cultures among 259 patients whose EVD sites were dressed with sterile semiocclusive dressings and underwent routine sterile dressing exchanges every 48 hours. They analyzed data obtained in an additional 113 patients whose EVD sites were dressed one time with a surgical adhesive, 2-octyl cyanoacrylate. Ventriculitis rate in patients with standard bioocclusive dressings and wound care was 15.1%, whereas that in patients with a 2-octyl cyanoacrylate dressing was 3.54% (p = 0.002). Staphylococcus genus accounted for 79.5% of instances of ventriculitis among patients with bioocclusive dressings and routine wound care, whereas it accounted for 25.0% of the instances of ventriculitis among patients with a liquid polymer sealant dressing. A 90% reduction in Staphylococcus infection completely accounts for the observed effect (p = 0.04). The one-time application of 2-octyl cyanoacrylate to EVD wounds and exit sites provided superior protection against EVD-related ventriculitis compared to conventional EVD-site wound care. Likely this protection results from a barrier to the entry of gram-positive skin flora along the EVD exit tract. The results should be validated in a randomized trial.

An Electronic Safety Screening Process during Inpatient Computerized Physician Order Entry Improves the Efficiency of Magnetic Resonance Imaging Exams

Delays between order and magnetic resonance (MR) exam often result when using the conventional paper-based MR safety screening process. The impact of an electronic MR safety screening process imbedded in a computerized physician order entry (CPOE) system was evaluated. Retrospective chart review of 4 months of inpatient MR exam orders and reports was performed before and after implementation of electronic MR safety documentation. Time from order to MR exam completion, time from MR exam completion to final radiology report, and time from first order to final report were analyzed by exam anatomy. Length of stay (LOS) and date of service within the admission were also analyzed. We evaluated 1947 individual MR orders in 1549 patients under an institutional review board exemption and a waiver of informed consent. Implementation of the electronic safety screening process resulted in a significant decrease of 1.1 hours (95% confidence interval 1.0-1.3 hours) in the mean time between first order to final report and a nonsignificant decrease of 0.8 hour in the median time from first order to exam end. There was a 1-day reduction (P = .697) in the time from admission to the MR exam compared to the paper process. No significant change in LOS was found except in neurological intensive care patients imaged within the first 24 hours of their admission, where a mean 0.9-day decrease was found. Benefits of an electronic process for MR safety screening include enabling inpatients to have decreased time to MR exams, thus enabling earlier diagnosis and treatment and reduced LOS.

Comparison of catheter-related large vein thrombosis in centrally inserted versus peripherally inserted central venous lines in the neurological intensive care unit

ObjectiveTo compare cumulative complication rates of peripherally (PICC) and centrally (CICVC) inserted central venous catheters, including catheter-related large vein thrombosis (CRLVT), central line-associated bloodstream infection (CLABSI), and line insertion-related complications in neurological intensive care patients. MethodsRetrospective cohort study and detailed chart review for 431 consecutive PICCs and 141 CICVCs placed in patients under neurological intensive care from March 2008 through February 2010. Cumulative incidence of CRLVT, CLABSI, and line insertion-related complications were compared between PICC and CICVC groups. Risk factors for CRLVT including mannitol therapy during dwell time, previous history of venous thromboembolism, surgery longer than 1h during dwell time, and line placement in a paretic arm were also compared between groups. ResultsDuring the study period, 431 unique PICCs were placed with cumulative incidence of symptomatic thrombosis of 8.4%, CLABSI 2.8%, and line insertion-related complications 0.0%. During the same period, 141 unique CICVCs were placed with cumulative incidence of symptomatic thrombosis of 1.4%, CLABSI 1.4%, and line insertion-related complications 0.7%. There was a statistically significant difference in CRLVT with no difference in CLABSI or line insertion-related complications. ConclusionsIn neurological critical care patients, CICVCs appear to have a better risk profile compared to PICCs, with a decreased risk of CRLVT. As use of PICCs in critical care patients increases, a prospective randomized trial comparing PICCs and CICVCs in neurological critical care patients is necessary to assist in choosing the appropriate catheter and to minimize risks of morbidity and mortality associated with central venous access.

Therapeutic hypothermia: the rationale

Therapeutic hypothermia: the rationale

Risk factors associated with peripherally inserted central venous catheter-related large vein thrombosis in neurological intensive care patients

Using Virchow's triad as a framework, we sought to identify risk factors independently associated with symptomatic peripherally inserted central venous catheter (PICC)-related large vein thrombosis (PRLVT) in neurological intensive care patients. A retrospective cohort study and detailed chart review were performed for 431 consecutive PICCs placed in patients admitted to our neurological intensive care unit between March 2008 and February 2010. Variables theorized to potentially increase the risk of PRLVT were abstracted from the medical record. Each variable was then tested for its independent association with PRLVT. During the study period, 431 PICCs were placed with an incidence rate for symptomatic thrombosis of 8.4%. In adjusted analysis, catheter placement in a paretic arm (OR, 9.85; 95% CI, 4.42-21.95), surgery longer than 1h during dwell time of the catheter (OR, 3.26; 95% CI, 1.48-7.17), a history of venous thromboembolism (OR, 6.66; 95% CI, 2.38-18.62), and mannitol use (OR, 3.27; 95% CI 1.27-8.43) were independently associated with the development of thrombosis. Alterations in blood flow and consistency, but not vessel injury, appear associated with symptomatic thrombosis following placement of PICCs in neurological intensive care patients. Mannitol use and placement in a paretic arm are potentially modifiable risk factors. Given the high incidence rate of symptomatic thrombosis, future studies should focus on comparing cumulative complications of centrally inserted venous catheters and PICCs in intensive care patients.

Short- and Long-Term Survival of Nonsurgical Intensive Care Patients and its Relation to Diagnosis, Severity of Disease, Age and Comorbidities

To identify variables associated with mortality in the ICU and 1 year following discharge. Prospective observational cohort study. ICU of a tertiary care center and university hospital. A total of 3,119 medical and neurological intensive care patients. Pre-admission health status was quantified by the sum of risk factors and chronic diseases. Severity of the acute disease was estimated by counting the number of organ dysfunctions and the Acute Physiology Score. Concerning the primarily affected organ system, ICU mortality was highest in hematological diseases (63%) and 1-year mortality was 82%. Lowest death rates were observed with metabolic (ICU 4%, 1-yr 18%) and psychiatric diagnoses (ICU 5%, 1-yr 13%). Greater severity of illness with the need for mechanical life support was associated with decreased 1-year survival. In the respiratory and in renal diseases, the artificial support of the primarily affected organ system incurred an ICU mortality equaling the average (23%) or below (14%) that of the whole ICU population. Pre-admission health status increased the probability of developing multiple organ failure and worsened outcome 1 year after discharge in non-cardiovascular patients. Age showed a weak correlation with chronic diseases and severity of the acute illness and was related to long-term, but not short-term survival. The most important risk factors associated with short- and long-term mortality in non-surgical intensive care patients are disease severity and the primarily affected organ system that necessitates admission. The artificial support of this organ system can improve only short-term outcome.

Nosocomial ventriculitis and meningitis in neurocritical care patients

External ventricular drainage (EVD) is frequently necessary in neurological and neurosurgical intensive care patients. A major complication of this procedure is an EVD-related venticulitis or meningitis. The purpose of this review is (1) to address the magnitude of the problem in the neurocritical care patient population, (2) to discuss the difficulties in providing an appropriate and timely diagnosis of this disease entity and (3) to propose an algorithm for both rapid diagnosis and appropriate therapy. A MEDLINE literature search was carried out for studies from January 1990 through March 2008 reporting on ventriculostomy, EVD-related central nervous system infections, in particular ventriculitis and meningitis. EVD-related ventriculitis is a serious nosocomial complication in the neurocritical care setting where EVD catheters are frequently used for the management of elevated ICP secondary to acute hydrocephalus primarily caused by subarachnoid and intraventricular hemorrhage or traumatic brain injury. Infection rate is high with reported incidences in the range of 5 % up to more than 20 %. Predisposing factors for infection are non-adherence to rigid insertion and maintenance protocols, leakage of cerebrospinal fluid (CSF), catheter irrigation and the frequency of EVD manipulation. Diagnosis is frequently impaired either by the presence of systemic inflammation due to the primary disease or because the hemorrhagic CSF itself may cause an inflammatory reaction. Furthermore, the most common pathogens involved in EVD-related infections, i. e., staphylococci, initially provoke only a mild inflammatory response in the CSF and therefore patients rarely present with clear-cut clinical signs indicating severe central nervous system infection, in particular, ventriculitis. Nosocomial EVD-related ventriculitis is a significant cause of morbidity and mortality in critically ill neurological patients. Rapid diagnosis and prompt initiation of appropriate antimicrobial therapy is needed. A stepwise algorithm for the management of EVD-related ventriculitis is proposed.

Retrospektive Analyse der Versorgung neurologischer Patienten einer internistischen Intensivstation

The aim of this study was to evaluate number and kind of neurological patients in comparison with other patients on a medical ICU. Over a period of one year, all neurological intensive care patients on a medical ICU were evaluated according to age, sex, diagnosis, mortality, diagnostic methods, ventilation and referral to other hospitals and general wards. Comparable to a specialist neurological ICU a wide spectrum of neurological diseases could be observed on an interdisciplinary ICU. In comparison to other patient groups, patients with neurological disease had a higher rate of ventilation, a longer hospital stay and a higher mortality. Our data also demonstrate the relevant amount of neurological patients (19 % measured by bed assignment) in comparison to all patients, and the specific neurological procedures were applicable on a medical/interdisciplinary ICU. A higher interest for neurological patient on a medical ICU would therefore be essential.

Periodic surveillance of nosocomial infections in two neurology intensive care units. A valuable tool for quality management in intensive care

Nosocomial infections are a common problem in intensive care therapy and have relevant influence on morbidity, mortality and associated costs. The aim of this study was to assess data on the epidemiology of nosocomial infections and related risk factors in neurological intensive care patients and to use them for internal quality management. Prospective periodic surveillance was performed in the first quarter of the years 1999 and 2000 in two neurology intensive care units. Within the surveillance period, 340 patients with 2443 patient days and a mean length of stay 7,6 days were enrolled. A total of 63 nosocomial infections were identified in 51 patients. In comparison with national reference data, device utilisation rates as well as device-associated nosocomial infection rates were on a higher level. By timely and interpretative feedback of the surveillance data, for the first time the unit-specific nosocomial infection situation was made clear for the ward staff. As a result, different quality management activities like establishment of evidence-based infection control guidelines, continuous surveillance for pneumonia and optimisation of empirical antibiotic therapy were initiated in both units. The establishment of periodic surveillance proved to be a valuable tool for the promotion of quality management activities in both intensive care units.

Use of Acute Physiology and Chronic Health Evaluation II in nontraumatic neurological intensive care patients: calibration and discrimination analysis

Use of Acute Physiology and Chronic Health Evaluation II in nontraumatic neurological intensive care patients: calibration and discrimination analysis

Color duplex measurement of cerebral blood flow volume in healthy adults.

Global cerebral blood flow (CBF) is an important yet largely unknown quantity in the treatment of neurological intensive care patients. Color duplex sonography of the extracranial cerebral arteries can be used to measure global CBF volume directly at the bedside. To establish reference data on global CBF volume and to test the influence of sex and age on this parameter, a prospective study was performed in a group of 78 healthy adults aged 20 to 85 years (39 women, 39 men; mean age, 52+/-19 years in either sex). The common, external, and internal carotid arteries and the vertebral arteries were examined with the use of a 7.0-MHz transducer of a computed sonography system. Angle-corrected time-averaged flow velocity and the diameter of the vessel were measured. Intravascular flow volumes were calculated as the product of angle-corrected time-averaged flow velocity and the cross-sectional area of the circular vessel. CBF volume was determined as the sum of flow volumes in the internal carotid and vertebral arteries of both sides. From 20 to 85 years of age, CBF volume decreased significantly (P</=0.0001), on average by approximately 3 mL/min per year. There were no sex-linked differences in CBF volume. The mean relative contributions of the internal carotid artery and the vertebral arteries to global CBF volume remained constant with age (76% versus 24%). The reference data on CBF volume established for the groups aged 20 to 39 years, 40 to 59 years, and 60 to 85 years were 727+/-102, 656+/-121, and 603+/-106 mL/min, respectively. The data presented here provide additional information on the natural development of global cerebral perfusion in "benign aging." CBF volume reference data for different age groups were also established. These data provide a basis for the clinical application of CBF volume measurements at the bedside, especially in the monitoring of CBF volume in neurological intensive care patients.

Can high fiber tube-fed formula reduce the incidence of constipation and diarrhea in neurological intensive care patients

Can high fiber tube-fed formula reduce the incidence of constipation and diarrhea in neurological intensive care patients

Follow-up and prognosis of patients of a neurologic intensive care unit with special reference to age

To evaluate risk factors effecting course and prognosis of neurological intensive care (ICU) patients with special respect to age, 422 patients (235 male, 187 female, mean age 56.7 years, standard deviation +/- 18.8 years) admitted to the ICU of the Department of Neurology, University Erlangen-Nürnberg, were retrospectively studied. The status at the time of ICU discharge was compared to that assessed 18-30 months later using the Barthel-Index, a five grade scale of independence, and the Glasgow Outcome Scale. At the time of reexamination, 203 of the 422 patients (48.2%) were still alive. The fatality rate increased with age. However, approximately 70% of the patients above the age of 70 years were still alive two years after ICU treatment with the majority of patients describing their life as satisfying. Multivariate analysis demonstrated that age by itself does not determine the course of disease. Age affects the prognosis only in combination with other variables such as preexisting diseases (e.g. stroke, carotid surgery, occlusive arterial disease), secondary complications (e. g. pneumonia), and specific ICU treatment (e.g. mechanical ventilation, nasogastric tube), and the patient's state at the time of ICU discharge (bedriddenness, aphasia, dementia).

Pattern of elevation of urine catecholamines in intracerebral haemorrhage.

Autonomic nervous system dysfunction is a common complication of severe intracranial disease. The aim of this study was to reveal the autonomic changes in patients suffering from acute intracerebral haemorrhage (ICH). 25 patients with spontaneous ICH within 24 hours of onset of symptoms were included. All patients were treated with standardised medical management and the meta- and normetanephrines were detected by high performance liquid chromatography (HPLC) in 24-hour urine every day. The mean level of normetanephrine (709 +/- 579 micrograms/day) and metanephrine (244 +/- 161 mg/day) were significantly elevated in comparison with a control group, p < or = 0.01. The norepinephrine elevation was of greater diagnostic and prognostic importance. Maximum urinary catecholamine metabolite levels occurred between day 3 to 10 after the bleeding. Normetanephrines correlated with the prognosis and the complications of ICH: intraventricular involvement resulted in significantly elevated normetanephrine levels (896 +/- 520 micrograms/day versus 311 +/- 78 micrograms/day) p < or = 0.01. Patients with a great volume of haematoma developed severe autonomic dysregulation (normetanephrines 1114 +/- 493 micrograms/day), whereas patients with smaller haematoma did not (339 +/- 125 micrograms/day) p < or = 0.0001; patients with bad outcome (1014 +/- 620 mg/day) had higher levels of normetanephrines than those with a good prognosis (322 +/- 110 micrograms/day) p < or = 0.001. A close relationship to elevated intracranial pressure was established. This study demonstrated the feasibility of detecting autonomic nervous system dysfunction in neurological intensive care patients by means of examination of the metabolites of the catecholamines in the urine.(ABSTRACT TRUNCATED AT 250 WORDS)

A personal computer-based system for online monitoring of neurologic intensive care patients

In the management of neurological intensive care patients with an intracranial space-consuming process the measurement and recording of intracranial pressure together with arterial blood pressure is of special interest. These parameters can be used to monitor the treatment of brain edema and hypertension. Intracranial pressure measurement is also important in the diagnosis of the various subtypes of hydrocephalus. Not only the absolute figures, but also the recognition of specific pressure-patterns is of particular clinical and scientific interest. This new, easily installed and inexpensive system comprises a PC and a conventional monitor, which are connected by an AD-conversion card. Our software, specially developed for this system demonstrates, stores and prints the online-course and the trend of the measurements. In addition it is also possible to view the online-course of conspicuous parts of the trend curve retrospectively and to use these values for statistical analyses. Object-orientated software development techniques were used for flexible graphic output on the screen, printer or to a file. Though developed for this specific purpose, this system is also suitable for recording continuous, longer-term measurements in general.

Neuromonitoring mit visuell evozierten Potentialen bei komatösen neurologischen Intensivpatienten

The application of visual evoked potentials (VEP) as a monitoring tool was studied in 40 comatose neurological intensive care patients. With increasing depth of coma, the number of detectable VEP components decreased. In deeply comatose patients, VEP were regularly displayed as a negative wave with a latency of app. 100 ms and an amplitude of app. 8 microV (N100). The administration of promethazine or flunitrazepam used as sedatives produced a decrease of amplitude and an increase of latency of N100 that was reversed within 30 or 60 min respectively. In 10 patients, in which intraventricular pressure (IVP) was measured continuously by means of an intraventricular catheter, it was found that increases of IVP produced a considerable decrease of the amplitude and area of N100; after reduction of the increased IVP, both parameters quickly recovered. These observations indicate that VEP may be a useful tool for neuro-monitoring in neurological intensive care patients.