Emergency and Critical Care Neurology

The emergency rooms of the three Charité Campi form one of the largest national and international emergency departments. A significant proportion of patients present with neurological chief complaints. In a first series of projects we investigate the clinical and epidemiological characteristics of major neurological disorders such as headache, vertigo, stroke and epilepsy. A second series of projects investigates initial management of disorders of consciousness, such as coma and delirium.

In 2002, two prospective randomized clinical trials showed that mild therapeutic hypothermia improves neurological outcome after cardiac arrest and resuscitation. Within the following years this therapy was slowly implemented in clinical routine. It became apparent that hypothermia influenced previously established markes for the prognosis of poor outocme in cardiac arrest patients. These markers have considerable clinical impact as they guide decisions on early limitation of intensive care. In collaboration with Christian Storm and colleagues of the department of Nephrology and Intensive Care Medicine of the Charité  we investigate the prognostic value of biomarkers, brain computed tomography, electrophysiological studies (SEP, EEG) and neurological examination in patients with hypoxic encephalopathy after cardiac arrest and resuscitation.

Each year, more than 2000 patients with acute vascular diseases are treated in our neurological departments. In several studies, we analyze the cerebral hemodynamic effects following different therapeutic procedures (e.g. induced blood pressure increase, hypothermia) during the acute stage of ischemic stroke. Furthermore, we try to establish further risk factors of early fatal edema in middle cerebral artery infarction. Other studies investigate clinical aspects after intracerebral and subarachnoid hemorrhage as well as innovative ultrasound techniques to detect cerebral vasospasm and perfusion deficits in these patients. Dynamic changes of different parameters in the cerebrospinal fluid after intraventricular and subarachnoid hemorrhage are analyzed as well as new therapeutic options in the treatment of cerebral arterial vasospasm.

Infections of the central nervous systems (CNS) are a major challenge in the treatment of patients on the neuro-intensiv care unit. Our main research focus is the investigation of CNS-infections that occur after invasive neuro-surgical procedures. The high number of patients that need to be treated with intracranial catheters on our interdisciplinary neuro-ICU allows investigation of large samples of various chemical and microbiological CSF-parameters.

Intensive care medicine is increasingly influenced by ethics guiding the treatment regimen. The improvement of treatment options improves possibilities to sustain life, whereas many people decide to restrict intensive care treatment in case they would suffer from severe illness. Especially, neuro-intensivists get involved in end-of-life decisions since many patients regard neurological deficits as reason to limit intensive care treatment. Our aim is to investigate how this development influences modern intensive care medicine in an interdisciplinary setting. Due to its high proportion of immigrants the Charité is well suited to establish research on cultural and religious influences on end-of-life decision making.