Neurocritical Care Programme

FAST is the recognised stroke recognition framework: Face drooping (one side of the face is drooping or numb, ask the person to smile — is it uneven?); Arm weakness (one arm is weak or numb, ask the person to raise both arms — does one drift down?); Speech difficulty (slurred speech, inability to speak, or not understanding what is being said); Time to call emergency. Additional stroke signs include sudden severe headache with no known cause (may indicate subarachnoid haemorrhage), sudden loss of vision in one eye, sudden severe dizziness, loss of balance, or loss of coordination. Any of these symptoms should trigger an immediate call to emergency services — not a wait-and-see approach. Stroke is a medical emergency.

For IV thrombolysis (clot-dissolving medication delivered through a vein), the treatment window is 4.5 hours from symptom onset. For mechanical thrombectomy (physical clot removal via a catheter in the artery), the window for imaging-selected patients extends to 24 hours from symptom onset based on the DAWN and DEFUSE-3 trials. However, the benefit of treatment decreases with time — the faster treatment is given, the better the outcome. The phrase "time is brain" reflects this: approximately 1.9 million neurons are lost for every minute an acute large vessel occlusion stroke is untreated. Call emergency services immediately at the first sign of stroke.

Status epilepticus is a seizure that lasts 5 minutes or more, or two or more seizures without recovery of consciousness between them. It is a neurological emergency. Generalised convulsive status epilepticus (visible convulsions) is recognisable, but non-convulsive status epilepticus (NCSE) — in which the brain is in a continuous seizure state without visible convulsions — is clinically invisible and requires continuous EEG to detect. Both require immediate treatment. Benzodiazepines (diazepam, midazolam, lorazepam) are first-line treatment, followed by IV antiepileptic loading (levetiracetam, sodium valproate, phenytoin) if the seizure continues. Refractory status epilepticus — which fails to respond to two or more antiepileptic drugs — requires ICU admission and anaesthetic agents (propofol, midazolam infusion, ketamine).

Subarachnoid haemorrhage (SAH) is bleeding into the subarachnoid space — the space between the brain and its outer covering — most commonly from a ruptured cerebral aneurysm. It presents as a thunderclap headache — a sudden, severe headache reaching maximum intensity within one minute, described by patients as the worst headache of their life. SAH requires immediate emergency assessment: a CT scan of the head (positive within 6 hours of onset in 98% of cases) and a lumbar puncture if CT is negative but the clinical suspicion is high (xanthochromia in the CSF confirms bleeding). The aneurysm must be secured urgently — either by surgical clipping or by endovascular coiling — to prevent re-rupture, which carries a 50–80% mortality. The KIMS neurovascular team manages both interventions.

A neuro-ICU (neurological intensive care unit) is a specialised ICU staffed and equipped to manage the specific needs of patients with severe neurological illness. The monitoring in a neuro-ICU extends beyond the heart and lungs — it includes continuous EEG for seizure detection, intracranial pressure (ICP) monitoring for traumatic brain injury and subarachnoid haemorrhage, transcranial Doppler for vasospasm monitoring after SAH, and specialised neurological nursing with training in assessment of consciousness, pupil reactivity, and focal neurological deficits. Management decisions in the neuro-ICU — when to give mannitol or hypertonic saline, when to escalate sedation for ICP, when to take a deteriorating patient to the operating room — require neurological expertise that is distinct from general critical care. At KIMS, the neuro-ICU is managed jointly by neurology and neurosurgery.

Once the acute stroke treatment (IV thrombolysis and/or thrombectomy) has been administered and the patient is stabilised, care transitions to the KIMS stroke unit — a dedicated ward with nursing trained in stroke care and access to physiotherapy, occupational therapy, and speech therapy. Secondary prevention — preventing a second stroke — begins immediately: antiplatelet therapy, anticoagulation for atrial fibrillation, aggressive blood pressure and cholesterol management, and lifestyle modification counselling. The KIMS Neurorehabilitation Programme coordinates the recovery phase: gait training, upper limb rehabilitation, communication therapy for aphasia, and cognitive rehabilitation. Most patients discharged from KIMS after stroke have a structured outpatient rehabilitation plan.

Yes, to a significant degree. Much of the damage from traumatic brain injury (TBI) is not caused by the initial impact alone — it is caused by secondary injury: the cascade of swelling, raised intracranial pressure, hypoxia, and hypotension that follow the primary impact. The goal of neurocritical care in TBI is to prevent or minimise secondary injury. This is done by: maintaining adequate blood pressure and oxygenation; monitoring and controlling intracranial pressure; avoiding hyperthermia; managing seizures; and ensuring adequate nutrition. In selected patients with severe TBI and refractory ICP elevation, decompressive craniectomy — removing part of the skull to allow the swollen brain to expand without herniation — can be life-saving. The KIMS neuro-ICU follows international TBI management protocols.

The KIMS Neuroscience emergency number is 040-46324365. This line is staffed 24 hours a day, 7 days a week. It connects directly to the KIMS Emergency, from which the neurology and neurosurgery in-house team is immediately activated. Do not wait to call if you are witnessing or experiencing symptoms of acute stroke, prolonged seizure, sudden severe headache, or rapid loss of consciousness or neurological function. Neurological emergencies are time-critical — earlier contact leads to faster treatment and better outcomes.