Neurocritical care
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Case Reports
Intrathecal saline infusion: an emergency procedure in a patient with spontaneous intracranial hypotension.
Spontaneous intracranial hypotension (SIH) is a neurologic condition with the prototypical symptom of orthostatic headache. We report a dramatic case of SIH with life-threatening bilateral hygroma and uncal herniation. ⋯ Intrathecal lumbal saline infusion in combination with ICP monitoring can be a life-saving treatment option in unstable SIH patients.
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The factors comprising the delays in management of status epilepticus (SE) have not been systematically studied. ⋯ Our study reveals unexpectedly and unacceptably long delays in SE management, stressing the importance of commitment to acknowledged management protocol. Delays in the treatment can and need to be shortened markedly by several strategies discussed in this article.
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Thromboembolic events and anticoagulation-associated bleeding events represent frequent complications following cardiac mechanical valve replacement. Management guidelines regarding the timing for resuming anticoagulation therapy following a surgically treated subdural hematoma (SDH) in patients with mechanical valves remains to be determined. ⋯ Interruptions in anticoagulation therapy for up to 3 weeks pose minimal thromboembolic risk in patients with mechanical heart valves. Close follow-up after discharge is highly recommended, as recurrent hemorrhages can occur several weeks after the resumption of anticoagulation.
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Intracerebral hemorrhage (ICH) causes 15 % of strokes annually in the United States. ⋯ Though the ICH admission rate increased and the in-hospital mortality decreased during the first epochs of the study, these have not significantly changed over the last two decades. ICH remains the most severe form of stroke with limited options to improve survival. More research targeting novel therapies to improve outcomes after ICH is desperately needed.
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Medically refractory status epilepticus, without an identifiable cause, post elective aneurysm clipping is a rare event. ⋯ Refractory status epilepticus, in the absence of an identifiable etiology, in elective aneurysm clipping is a rare event. Consideration should be given for the early use of ketamine in refractory status epilepticus.