Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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The Glasgow Coma Scale (GCS) is the most universally accepted system for grading level of consciousness. Predicting outcome is particularly difficult in poor grade aneurysmal subarachnoid haemorrhage (aSAH) patients. We hypothesised that the GCS and individual examination components would correlate with long-term outcome and have varying prognostic value depending on assessment time points. ⋯ Long-term follow-up is necessary when evaluating recovery after aSAH, as outcomes improve significantly during the first year. The GCS and its individual components correlate well with long-term outcome. Admission motor examination and spontaneous eye opening during hospitalisation are most predictive of favourable recovery.
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Case Reports
Fatal intratumoral hemorrhage in posterior fossa tumors following ventriculoperitoneal shunt.
We report on two patients with rare major intratumoral hemorrhage following ventriculoperitoneal shunt in posterior fossa tumors. A 28-year-old woman with a midline posterior fossa lesion, whose imaging features suggested a fourth ventricular ependymoma with obstructive hydrocephalus, was subjected to a right ventriculoperitoneal shunt. Her consciousness deteriorated, and she experienced massive intratumoral hemorrhage and later died. ⋯ She also developed a massive tumor bleed following a ventriculoperitoneal shunt and was subjected to emergency decompression of the tumor with the bleeding. She remained vegetative at discharge and died 18 months later. Intratumoral hemorrhage is a rare but important cause of morbidity and mortality in patients with posterior fossa tumors who undergo ventriculoperitoneal shunt.
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Airway management during anaesthesia for intracranial procedures has traditionally been by endotracheal intubation. We present three cases of radiological coiling of cerebral aneurysms during which a supraglottic airway device was used. This avoided the need for endotracheal intubation and the associated risks. We believe the use of a supraglottic airway device is a safe alternative to endotracheal intubation during coiling of cerebral aneurysms.