Neurology India
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A rare case of a mid brain venous angioma with obstructive hydrocephalus is described. A dilated draining vein from the lesion in the aqueduct as the cause of the hydrocephalus is highlighted, and interesting features of the pathology of venous angiomas and associated cavernous hemangioma are described. The management of this interesting condition is discussed.
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The neurointensivist needs to have a thorough understanding of hemodynamic issues and the interaction of the brain and the cardiovascular system. Before one decides to intervene and try to correct an apparent "abnormal hemodynamic parameter" one needs to think whether such an intervention is indeed warranted and what effect the intervention would have on the cerebral circulation. The neurointensivist thus needs to approach these issues differently from the approach an internist or general intensivist would take.
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Increased intracranial pressure (ICP) is a pathological state common to a variety of neurological diseases, all of which are characterized by the addition of volume to the skull contents. Elevated ICP may lead to brain damage or death by two principle mechanisms: 1) global hypoxic-ischemic injury, as a consequence of reduced cerebral perfusion pressure (CPP) and cerebral blood flow; and 2) mechanical distortion and compression of brain tissue as a result of intracranial mass effect and ICP compartmentalization. All ICP therapies have as a goal, reduction of intracranial volume. ⋯ Application of moderate hypothermia (32 to 33 degrees C) shows promise as a newer method for treating refractory ICP. Placement of an ICP monitor is the critical first step in management of ICP. Treatment is best done using a stepwise protocol, with careful attention to sedation and CPP control prior to using mannitol and hyperventilation.
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Nosocomial infections are common among hospitalized patients, more so in intensive care units (ICU). They contribute significantly to morbidity, mortality and cost of care. Few studies address the issue of nosocomial infections in Neurology and neurosurgery ICUs, (NNICU) and data from other ICUs probably cannot be extrapolated to acutely ill neurologic patients. ⋯ Nosocomial infections are common and to a large extent, preventable. However, an established infection by multidrug resistant bacteria is difficult to treat and results in a high mortality, morbidity and cost of care. This article addresses nosocomial infections in the context of the Neurology and Neurosurgery ICU (NNICU).