Acute brain injuries pose a great threat to global health, having significant impact on mortality and disability. Patients with acute brain injury may develop distant organ failure, even if no systemic diseases or infection is present. The severity of non-neurologic organs’ dysfunction depends on the extremity of the insult to the brain. In this comprehensive review we sought to describe the organ-related consequences of acute brain injuries. The clinician should always be aware of the interplay between central nervous system and non-neurological organs, that is constantly present. Cerebral injury is not only a brain disease, but also affects the body as whole, and thus requires holistic therapeutical approach.

Febrile Infection-Related Epilepsy Syndrome (FIRES) is a catastrophic, extremely rare epileptic encephalopathy. It strikes previously healthy school-aged children and is usually cryptogenic. Its dramatic onset with refractory status epilepticus is always preceded by a nonspecific febrile illness. The seizure activity in FIRES may last for several weeks with little to no response to antiepileptic treatment, usually resulting in the usage of anaesthetics. This acute phase is followed by a chronic, refractory epilepsy and cognitive deficit, that persist for the rest of the patient’s life. Still to this day no definite cause has been described. In this study we review the current finding in FIRES and describe a case of a 4-year-old patient with a dramatic course of the acute phase in FIRES and unusual presentation of the chronic phase, which is dominated by extrapyramidal symptoms such as dystonia. This case highlights that the clinical presentation of FIRES may differ from those frequently described in literature.

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Delirium is a life-threatening condition, the causes of which are still not fully understood. It may develop in patients with pre-existing dementia. Delirium superimposed on dementia (DSD) can go completely unnoticed with routine examination. It may happen in the perioperative period and in the critical care setting, especially in the ageing population. Difficulties in diagnosing and lack of specific pharmacological and non-pharmacological treatment make DSD a seriously growing problem. Patient-oriented, multidirectional preventive measures should be applied to reduce the risk of DSD. For this reason, anesthesiologists and intensive care specialists should be aware of this interesting condition in their everyday clinical practice.

Background: Relatives of critically ill patients who either die or survive the intensive care unit (ICU) may develop substantial mental health problems that are collectively defined as Post-Intensive Care Syndrome in Family (PICS-F). It is important to document in a systematic manner all of the possible risk factors associated with the development of the latter.Methods: By using a systematized search strategy we included studies that focused on PICS-F in relatives of adult ICU patients and reported the risk factors associated with its development. The search was conducted within PubMed, Embase, SCOPUS, clinicaltrials.gov and Cochrane Library on the 2nd of May, 2021. PRISMA guidelines were implemented for appropriate reporting. Results: We included 52 papers covering 8293 relatives. The prevalence of PICS-F varied between 2.5-69%. We identified over 70 different risk factors of PICS-F, among which we distinguished patient-related (n=28), relative-related (n=33) and medical staff-related (n=9) risk factors. Among 17 studies with the highest quality we identified the 7 following factors associated with the development of PICS-F: younger age of a patient, death of a patient, depression in relatives during the ICU stay, history of mental disorders in relatives, being a spouse and low satisfaction with communication & care in the ICU.Conclusions: PICS-F is a highly prevalent phenomenon that may be exacerbated by a number of risk factors. Special attention should be paid to proper identification of susceptible relatives in order to prevent PICS.