Transcranial color-coded Doppler sonography (Envisor, Philips Medical Systems, Bothell, WA, USA) was performed daily by a neurointensivist in unconscious patients and in awake patients with symptoms (deteriorating consciousness, focal deficit, headache, fever, confusion) as part of the routine screening protocol used in our ICU.
Traumatic brain injury (TBI) is a debilitating neurological disorder defined as an injury from an external source resulting in a period of altered consciousness and deficits in physical, cognitive, and/or psychosocial functioning.
Patients with impairment of consciousness, neurological deficits, or seizures, underwent cranial computed tomography (CT) before lumbar puncture.
Delirium is an acute temporary and fluctuating mental-organic syndrome, characterized by a global impairment of cognitive function, reduced level of consciousness, attentional deficits and altered sleep-wake cycle, and changes in arousal (hyperactive, hypoactive, or mixed).
In the past, we relied on clinical signs that have relatively low diagnostic accuracy (47% to 87%), especially when the patient had a decreased consciousness level, neurological deficit, other associated injuries, or was under the influence of drugs or medications [2].
The patient had a severely-affected central nervous system with obtunded consciousness, facial nerve deficit and meningeal signs.
All analyses are adjusted for age, sex, ethnicity, socioeconomic status, stroke subtype, level of consciousness, incontinence, motor deficit, dysphagia, and year of stroke.
Emboli may cause a wide variety of clinical symptoms and signs, including impaired consciousness or focal deficits, depending on their size, location, and number.
