Neurologic Emergencies (DRAFT)

2018 ◽  
Author(s):  
Tamara Kaplan ◽  
Tracey Milligan
Keyword(s):  
Status Epilepticus ◽  
Intracranial Pressure ◽  
Subarachnoid Haemorrhage ◽  
Vascular Malformation ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Increased Intracranial Pressure ◽  
Cerebral Vasoconstriction ◽  
Neurologic Emergencies

The video in this chapter discusses neurologic emergencies, including the symptoms of increased intracranial pressure leading to herniation, subarachnoid haemorrhage (can be due to aneurysm, vascular malformation, or reversible cerebral vasoconstriction syndrome, and definition and management of status epilepticus.

Neurologic Emergencies

2019 ◽  
pp. 125-136
Author(s):  
Ross P. Martini ◽  
Ines P. Koerner
Keyword(s):  
Status Epilepticus ◽  
Intracranial Pressure ◽  
Structure And Function ◽  
Neurosurgical Procedures ◽  
Transition Of Care ◽  
Comatose Patient ◽  
Neurologic Emergencies ◽  
Brain Structure And Function ◽  
Key Aspects ◽  
And Function

The primary goal of the neuroanaesthetist and neurointensivist is to preserve brain structure and function, especially in the setting of neurologic insults. Neurologic emergencies can also develop peri-operatively in patients undergoing non-neurosurgical procedures, which the general anaesthetist should be prepared to manage. This chapter on neurologic emergencies discusses herniation syndromes (including pathophysiology of intracranial hypertension, symptoms of herniation, and therapies to reduce intracranial pressure and reverse herniation). It also covers coma (including differential diagnoses of postoperative coma, clinical evaluation of the comatose patient, CT imaging, advanced tests, and directed therapies). Finally, it discusses key aspects of ischaemic stroke, status epilepticus, and transition of care.

Neurology

2013 ◽  
Author(s):  
Martin Beed ◽  
Richard Sherman ◽  
Ravi Mahajan
Keyword(s):  
Traumatic Brain Injury ◽  
Intensive Care ◽  
Status Epilepticus ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Subarachnoid Haemorrhage ◽  
Metabolic Disorders ◽  
Raised Intracranial Pressure ◽  
Thromboembolic Stroke ◽  
Neurological State

Decreased consciousnessSeizures and status epilepticusStroke/thromboembolic strokeIntracerebral haemorrhageSubarachnoid haemorrhageTraumatic brain injuryRaised intracranial pressureMeningitis and encephalitisAgitation/confusion/aggressionAlcohol withdrawalNeuromuscular weakness and paralysisGuillain–Barré syndromeMyasthenia gravis↓consciousness occurs in many diseases requiring admission to intensive care, and is often a cause for admission in its own right. Changes in neurological state may be related to intracranial pathology, or may occur in response to respiratory, circulatory, or metabolic disorders....

093 Clinical and imaging discordance in reversible cerebral vasoconstriction syndrome

2018 ◽  
Vol 89 (6) ◽  
pp. A37.2-A37 ◽  
Author(s):  
Michael J Devlin ◽  
Archana Dwivedee ◽  
Richard P White
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Cerebral Arteries ◽  
Clinical Status ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Clinical State ◽  
Cerebral Vasoconstriction ◽  
Csf Analysis ◽  
Elevated Protein ◽  
Digital Subtraction Angiogram ◽  
Reversible Encephalopathy

IntroductionReversible cerebral vasoconstriction syndrome (RCVS) is to be suspected in cases of thunderclap headache particularly when associated with convex subarachnoid haemorrhage without cerebral aneurysm. Angiographic changes and clinical state do not always correlate. We present a case report from the Townsville Hospital.CaseA 49 year old female presented to another hospital with recurrent thunderclap headaches first commencing with exercise. The medical history included idiopathic intracranial hypertension in remission, chronic migraine treated with botulinum toxin, and depression treated with amitriptyline and desvenlafaxine. MR imaging revealed cerebral vertex subarachnoid haemorrhage with normal MR angiogram of the cerebral vessels. The patient was transferred to our institution in a confused and restless state for cerebral digital subtraction angiogram, which was normal. A lumbar puncture revealed elevated white cells of 17×106/L with normal CSF protein and opening pressure of 39 cm H2O. Nimodipine that had been commenced before the patient became encephalopathic was ceased. Her confusion and headaches resolved but relapsed after three days. A repeat MR brain revealed multiple T2 hyperintensities in bilateral anterior and posterior circulation territories demonstrating diffusion restriction, and MR angiography revealed new segmental strictures and beading of bilateral middle and anterior cerebral arteries. The patient was diagnosed with overlap RCVS/posterior reversible encephalopathy syndrome; desvenlafaxine was ceased, acetazolamide commenced for raised intracranial pressure and a several week course of nimodipine recommenced. The patient was discharged home after resolution of headache and confusion without neurological deficit.ConclusionThis case highlights the dynamic changes of vasoconstriction and that angiographic findings can be discordant from the clinical status. Serial imaging is required to detect abnormalities of RCVS when the clinical suspicion is high. CSF analysis can be normal, however may reveal elevated protein or pleocytosis. The cause of our patient’s RCVS was thought to be the chronic use of desvenlafaxine.

scholarly journals Acute Headache at Emergency Department: Reversible Cerebral Vasoconstriction Syndrome Complicated by Subarachnoid Haemorrhage and Cerebral Infarction

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
M. Yger ◽  
C. Zavanone ◽  
L. Abdennour ◽  
W. Koubaa ◽  
F. Clarençon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Subarachnoid Haemorrhage ◽  
Cerebral Arteries ◽  
Brain Mri ◽  
Occipital Lobe ◽  
Haemorrhagic Stroke ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Cerebral Vasoconstriction ◽  
The Right ◽  
The Brain

Introduction.Reversible cerebral vasoconstriction syndrome is becoming widely accepted as a rare cause of both ischemic and haemorrhagic stroke and should be evocated in case of thunderclap headaches associated with stroke. We present the case of a patient with ischemic stroke associated with cortical subarachnoid haemorrhage (cSAH) and reversible diffuse arteries narrowing, leading to the diagnosis of reversible vasoconstriction syndrome.Case Report.A 48-year-old woman came to the emergency department because of an unusual thunderclap headache. The computed tomography of the brain completed by CT-angiography was unremarkable. Eleven days later, she was readmitted because of a left hemianopsia. One day after her admission, she developed a sudden left hemiparesis. The brain MRI showed ischemic lesions in the right frontal and occipital lobe and diffuse cSAH. The angiography showed vasoconstriction of the right anterior cerebral artery and stenosis of both middle cerebral arteries. Nimodipine treatment was initiated and vasoconstriction completely regressed on day 16 after the first headache.Conclusion.Our case shows a severe reversible cerebral vasoconstriction syndrome where both haemorrhagic and ischemic complications were present at the same time. The history we reported shows that reversible cerebral vasoconstriction syndrome is still underrecognized, in particular in general emergency departments.

scholarly journals Reversible cerebral vasoconstriction syndrome in a postpartum female complicated by subarachnoid haemorrhage

2011 ◽  
Vol 2011 (jul28 1) ◽  
pp. bcr0620114342-bcr0620114342 ◽  
Author(s):  
R. Zakaria ◽  
I. Coulter ◽  
P. Enevoldson ◽  
P. May
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Cerebral Vasoconstriction
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