Neurocritical care
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Case Reports
Posterior reversible encephalopathy syndrome caused by hypertensive encephalopathy and acute uremia.
The posterior reversible encephalopathy syndrome (PRES) is a recently proposed cliniconeuroradiological entity. The most common causes of PRES are hypertensive encephalopathy, eclampsia, cyclosporin A neurotoxicity, and the uremic encephalopathy. On magnetic resonance imaging (MRI) studies, edema has been reported in a relatively symmetrical pattern, typically in the subcortical white matter and occasionally in the cortex of the posterior circulation area of the cerebrum. ⋯ Particular attention needs to be given to PRES because initiation of appropriate intervention can reverse the encephalopathic condition in most cases. Cerebral lesions may be more prominent in the anterior circulation area in some patients.
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Case Reports
Anesthetic management of the pregnant patient for endovascular coiling of an unruptured intracranial aneurysm.
Diagnosis of an intracranial aneurysm during pregnancy is a rare event requiring multidisciplinary care for successful management. The knowledge base for the anesthesiologist involves principles of both obstetric and neuroanesthesia, as well as critical care. This article reports such a case and discusses the relevant pathophysiology, along with details of the perioperative management by the anesthesiology team.
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Blood coagulation and hemostasis issues are important aspects of patient care in acute neurosurgical patients. Coagulopathy often complicates the already difficult management of cerebrovascular and intracranial hemorrhagic disease and injuries, adding to the already high associated morbidity and mortality. Common causes of coagulopathy, as well as its management in acute neurosurgical settings, are outlined in this review. Awareness of how to promptly evaluate and effectively treat coagulopathic processes is instrumental to the success of the neurosurgeon in managing acute intracranial pathologies.