Key messages

• Diseases of the nervous system seen in the intensive care unit can occur as a result of involvement of either the central or the peripheral nervous system. Knowledge of the relevant neuroanatomy is crucial to localize the lesion.

• Consciousness comprises alertness and awareness. Alertness depends on the ascending reticular activating system. The cerebral cortex, with extensive intracortical connections and interactions with subcortical structures, governs awareness and cognition. For disorders of cognition, it is best to describe the clinical features and to localize the particular deficit.

• Although many central nervous system functions are localized in discrete regions, the latter have rich interconnections with other brain components. Control of ventilation is ultimately dependent on centers in the medulla, but limbic and forebrain motor areas have strong temporarily overriding influences. Clinical and electrophysiological evaluation can determine the sites in the central and peripheral nervous systems that produce disorders of ventilation. The hypothalamus is the principal center for homeostasis, but peripheral receptors and higher central nervous system structures have considerable influence.

• The motor system is organized in a heirarchical fashion, including executive planning centers and regions for postural control and fine movements. These are integrated with other regions, many subcortical, which co-ordinate and smooth the movements. Sensory feedback is an essential component of motor performances.

• A knowledge of how nerve action potentials are generated, and of the basic mechanism of neuromuscular transmission and excitation-contraction coupling of muscle, is important to comprehend the pathophysiological mechanisms behind diseases of the peripheral nervous system seen in the intensive care unit, and also to understand their treatment.

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