Neurological emergencies

2019 ◽  
pp. 347-468
Author(s):  
Punit S. Ramrakha ◽  
Kevin P. Moore ◽  
Amir H. Sam
Keyword(s):  
Cord Compression ◽  
Acute Bacterial Meningitis ◽  
Raised Intracranial Pressure ◽  
Limb Weakness ◽  
Neurological Emergencies ◽  
Transient Ischaemic Attacks ◽  
Brainstem Stroke ◽  
Brainstem Function ◽  
Confusional States ◽  
Space Occupying Lesion

This chapter discusses neurological emergencies, including coma, limb weakness, acute dizziness, acute loss of vision, painful red eye, acute bacterial meningitis, acute viral encephalitis, head injury, raised intracranial pressure (ICP), intracranial space-occupying lesion, haemorrhage (intracerebral, extradural, subdural, subarachnoid), status epilepticus (tonic–clonic), stroke, cerebral infarction syndromes, brainstem stroke, cerebellar stroke, transient ischaemic attacks (TIAs), confusional states and delirium, acute alcohol withdrawal, neuromuscular respiratory failure, myasthenic crises, spinal cord compression, Guillain–Barré syndrome (GBS), botulism, tetanus, the Glasgow Coma Scale (GCS), examination of brainstem function, and brain death.

scholarly journals Posttraumatic thoracic epidural capillary hemangioma – A rare case report

2020 ◽  
Vol 11 ◽  
pp. 179 ◽  
Author(s):  
G. Sudhir ◽  
Vignesh Jayabalan ◽  
T. H. Manohar ◽  
Saikrishna Gadde ◽  
Venkatesh Kumar ◽  
...  
Keyword(s):  
Epidural Space ◽  
Lower Limb ◽  
Histopathological Examination ◽  
Cord Compression ◽  
Capillary Hemangioma ◽  
Vascular Lesions ◽  
Surgical Removal ◽  
En Bloc ◽  
Limb Weakness ◽  
Thoracic Epidural

Background: Capillary hemangiomas are benign vascular lesions commonly seen in subcutaneous tissues. The most common site of origin is from the vertebral body, and only a few cases of isolated lesions in thoracic epidural space, especially after trauma, have been reported in the literature. Case Description: We report a case of 63-year-old male with progressive bilateral lower limb weakness and exaggerated lower limb deep tendon reflexes without bowel and bladder involvement. His history revealed T7 fracture with paraparesis which was treated surgically, and implants were removed a year later. MRI showed an epidural lesion from T6-T8 extending into the right T7-8 foramen which showed hypointensity on T1, hyperintensity on T2, and homogenous enhancement in contrast images with severe cord compression. Laminectomy was done and the lesion was removed en bloc. Histopathological examination revealed it to be capillary hemangioma. The neurology came back to normal after 3 months. Conclusion: Although capillary hemangiomas are rare lesions, it has to be considered in the differential diagnosis of epidural space-occupying lesions which require early surgical removal to prevent a progressive and permanent neurological deficit.

scholarly journals Self-Reported Knowledge Levels of Critical Care Nurses in Managing Neuroemergencies: A Survey Based Study

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Karan Amlani ◽  
Sonia Nelson ◽  
Elka Riley ◽  
Zachary L Hickman ◽  
Christopher P Kellner ◽  
...  
Keyword(s):  
Critical Care ◽  
Intracranial Pressure ◽  
Work Experience ◽  
Neurocritical Care ◽  
Spine Injury ◽  
Postanesthesia Care Unit ◽  
Raised Intracranial Pressure ◽  
Neurological Emergencies ◽  
Level Of Training ◽  
Comprehensive Stroke Center

Abstract INTRODUCTION Neurocritical care has become increasingly subspecialized. However, due to a lack of bed availability in neurocritical care units (NCCUs), sometimes patients may need to be boarded in other intensive care units (ICUs). Several academic centers do not have access to dedicated NCCUs. We hypothesized that general ICU and postanesthesia care unit (PACU) nurses may not feel as comfortable managing neurocritical care patients. In this survey-based quality improvement (QI) study, we explored the self-reported knowledge of ICU and PACU nurses at a comprehensive stroke center in recognizing and managing some common neurological emergencies such as stroke, status epilepticus, and raised intracranial pressure. METHODS We engaged the nursing managers of 8 units in this QI project, which included medical, surgical, neurocritical care, cardiac and cardiothoracic units as well as PACU and interventional radiology units. Using institutional RedCap, anonymized surveys were sent to the nurses in January 2019. We collected information on demographic and critical care work experience. All participants answered questions on a Likert-type scale based on their knowledge of several common neurological emergencies. RESULTS A total of 240 nurses (199 females, 41 males) participated in the survey. Out of which, 112 (58%) had been working in an ICU for 3 yr or longer. Their self-reported level of knowledge in managing neurological emergencies have been summarized below. More than half the participants did not feel comfortable managing patients with EVDs, ICH, SAH, raised intracranial pressure, and TBI and traumatic spine injury patients. More than 70% of nurses were not satisfied with their current level of training to deal with neuroemergency and supported the need for dedicated training/study time. CONCLUSION ICU and PACU nurses report gaps in knowledge in recognizing and managing common neuroemergencies. With an increasing cohorting of patients in subspecialized units, it is important to provide ongoing education to ICU and PACU nurses to help them maintain fundamental neurocritical knowledge.

scholarly journals Spinal cord compression secondary to vertebral echinococcosis

2016 ◽  
Vol 7 (01) ◽  
pp. 143-146 ◽  
Author(s):  
Abat Sahlu ◽  
Brook Mesfin ◽  
Abenezer Tirsit ◽  
Knut Wester
Keyword(s):  
Muscular Strength ◽  
Cord Compression ◽  
Lower Limbs ◽  
Resonance Imaging ◽  
Limb Weakness ◽  
Lower Limb Weakness ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Anterior Plating

ABSTRACTWe describe a patient with progressive lower limb weakness and paresthesia 3 days after falling from a considerable height. Magnetic resonance imaging and computed tomography revealed collapsed Th2 and Th3 vertebrae. A tuberculous (TB) spondylitis was suspected, and anti-TB medication was started however with no clinical improvement. She was referred to our center and operated. A 3 level discectomy and 2 level corpectomy were performed with iliac bone grafting and anterior plating via an anterior cervical approach. The patient developed an esophagocutaneous fistula that was repaired and cured. The biopsy specimen showed a hydatid cyst of the vertebra as the cause of the lesion. After the result, she was started on oral albendazole. At follow-up nearly 4 months after surgery, the patient had regained significant power in her lower limbs with a muscular strength of 5/5 in both legs, thus making it possible to walk without support.

scholarly journals Degenerative cervical myelopathy presenting as subjective lower limb weakness could be a trap towards misdiagnosis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Chi-An Luo ◽  
Meng-Ling Lu ◽  
Arun-Kumar Kaliya-Perumal ◽  
Lih-Huei Chen ◽  
Wen-Jer Chen ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Functional Recovery ◽  
Lower Limb ◽  
Cervical Myelopathy ◽  
Cord Compression ◽  
Surgical Decompression ◽  
Limb Weakness ◽  
Lower Limb Weakness ◽  
Tandem Spinal Stenosis ◽  
Degenerative Cervical Myelopathy

AbstractWhen patients presenting with subjective lower limb weakness (SLLW) are encountered, it is natural to suspect a lumbar pathology and proceed with related clinical examination, investigations and management. However, SLLW could be a sign of degenerative cervical myelopathy (DCM) due to an evolving cord compression. In such circumstances, if symptoms are not correlated to myelopathy at the earliest, there could be potential complications over time. In this study, we intend to analyse the outcomes after surgical management of the cervical or thoracic cord compression in patients with SLLW. Retrospectively, patients who presented to our center during the years 2010–2016 with sole complaint of bilateral SLLW but radiologically diagnosed to have a solitary cervical or thoracic stenosis, or tandem spinal stenosis and underwent surgical decompression procedures were selected. Their clinical presentation was categorised into three types, myelopathy was graded using Nurick’s grading and JOA scoring; in addition, their lower limb functional status was assessed using the lower extremity functional scale (LEFS). Functional recovery following surgery was assessed at 6 weeks, 3 months, 6 months, one year, and two years. Selected patients (n = 24; Age, 56.4 ± 10.1 years; range 32–78 years) had SLLW for a period of 6.4 ± 3.2 months (range 2–13 months). Their preoperative JOA score was 11.3 ± 1.8 (range 7–15), and LEFS was 34.4 ± 7.7 (range 20–46). Radiological evidence of a solitary cervical lesion and tandem spinal stenosis was found in 6 and 18 patients respectively. Patients gradually recovered after surgical decompression with LEFS 59.8 ± 2.7 (range 56–65) at 1 year and JOA score 13.6 ± 2.7 (range − 17 to 100) at 2 years. The recovery rate at final follow up was 47.5%. Our results indicate the importance of clinically suspecting SLLW as an early non-specific sign of DCM to avoid misdiagnosis, especially in patients without conventional upper motor neuron signs. In such cases, surgical management of the cord compression resulted in significant functional recovery and halted the progression towards permanent disability.

scholarly journals Metastatic epidural spinal cord compression

2020 ◽  
Vol 2020 (8) ◽  
Author(s):  
Preci Hamilton ◽  
Peyton Lawrence ◽  
Christian Valentin Eisenring
Keyword(s):  
Spinal Cord ◽  
Stereotactic Radiosurgery ◽  
Spinal Cord Compression ◽  
Scoring Systems ◽  
Cord Compression ◽  
Tumor Burden ◽  
Pedicle Screw Fixation ◽  
Limb Weakness ◽  
Neoplastic Lesion ◽  
Spinal Sagittal Alignment

Abstract Up-to-date management for metastatic epidural spinal cord compression is based on appropriate scoring systems. In this case, separation surgery and stereotactic radiosurgery achieved an optimized outcome. A 75-year-old man had thoracic band-like pain, left lower limb weakness and difficulty ambulating for 6 weeks. Spinal images showed a T4 metastatic epidural spinal cord compression with a pathological fracture of T4 and T10 and L3 lytic lesions. There was no other neoplastic lesion. The metastasized T4 was decompressed by a posterolateral right costotransversectomy, vertebrectomy and insertion of an expandable titanium cage. The spinal sagittal alignment was restored with T1–T7 pedicle screw fixation. Post-operatively the pain and motor power improved significantly so that the patient was discharged home. Separation surgery and adjuvant stereotactic radiosurgery of the spine successfully improved tumor burden, pain control and overall prognosis.

Neurology

2021 ◽  
pp. 383-444
Author(s):  
Nguyen Thi Hoang Mai ◽  
Mary Warrell ◽  
Charles Newton ◽  
Diana Lockwood
Keyword(s):  
Spinal Cord ◽  
Status Epilepticus ◽  
Peripheral Neuropathy ◽  
Intracranial Pressure ◽  
Bacterial Meningitis ◽  
Viral Meningitis ◽  
Acute Bacterial Meningitis ◽  
Extradural Haematoma ◽  
Raised Intracranial Pressure ◽  
Subdural Haemorrhage

Impaired consciousness, Headache, Raised intracranial pressure, Acute bacterial meningitis, Epidemic meningococcal disease, Viral meningitis, Chronic meningitis, Encephalitis, Rabies, Tetanus, Stroke, Subarachnoid haemorrhage, Subdural haemorrhage, Extradural haematoma, Blackouts/syncope, Space-occupying lesions (SOL), Brain abscess, Hydrocephalus, Epilepsy, Status epilepticus, Cysticercosis, Weak legs and spinal cord disease, Guillain-Barré syndrome, Poliomyelitis (polio), Peripheral neuropathy, Leprosy, Dementia

Case of Metastasis of Alveolar Soft Part Sarcoma Lower Limb To Brain Diagnosed on Squash Cytology

JMS SKIMS ◽  
2017 ◽  
Vol 20 (2) ◽  
pp. 108
Author(s):  
Sumat Ul Khurshid ◽  
Iqbal Lone ◽  
Imza Feroz ◽  
Wajahat Mir
Keyword(s):  
Lower Limb ◽  
Soft Part ◽  
Low Density ◽  
Parietal Region ◽  
Limb Weakness ◽  
Left Lower Limb ◽  
History Of ◽  
One Year ◽  
The Brain ◽  
Space Occupying Lesion

A 19‑year‑old male patient was admitted, after experiencing occasional headaches during the previous 6 months. The patient's headaches had become progressively more severe 1 month prior to admis­sion to hospital, and were associated with right upper limb weakness. As revealed by cranial computed tomog­raphy, a high‑density lesion was observed in the left parietal region [CT values, 52 Houns field units, (HU)] and a peripheral low‑density edematous zone was visible.(figure a) . The medical history of the patient included an indolent 4x4 cm subcutaneous iliac mass in the left lower limb from last one year, which the patient had neglected. Therefore, the patient was diagnosed as space occupying lesion brain. During surgery, a purplish‑red tumor was observed in the brain. Intraoperative crush cytology was asked for. JMS 2017;20(2):108

scholarly journals New onset headache caused by histiocytic sarcoma of the spinal cord and leptomeninges: a case report

2021 ◽  
Vol 3 (1) ◽  
pp. e000147
Author(s):  
Matthew Silsby ◽  
Winny Varikatt ◽  
Steve Vucic ◽  
Parvathi Menon
Keyword(s):  
Spinal Cord ◽  
Intracranial Pressure ◽  
Diagnostic Delay ◽  
Cauda Equina ◽  
Histiocytic Sarcoma ◽  
Raised Intracranial Pressure ◽  
Limb Weakness ◽  
Cerebral Pathology ◽  
Pressure Headache ◽  
New Onset

BackgroundHeadache due to raised intracranial pressure is rarely caused by spinal lesions. We describe a patient with primary histiocytic sarcoma who presented with a new onset headache with features of raised intracranial pressure and subtle signs of cauda equina syndrome due to predominant lower spinal cord infiltration and minimal intracranial involvement.CaseA previously well 54-year-old man presented with a 2-month history of new onset headache with features of raised intracranial pressure. Progression of lower limb weakness was delayed and mild with diagnostic delay resulting from the primary presentation with headache leading to an initial focus on cerebral pathology. Subsequent investigations revealed a previously unreported presentation of primary histiocytic sarcoma infiltrating the cauda equina causing raised intracranial pressure headache.ConclusionThis case highlights the importance of a broad search in the investigation of new onset raised intracranial pressure headache, including imaging of the lower spinal cord. Primary histiocytic sarcoma should be considered in the differential diagnosis of this rare syndrome.

scholarly journals Neurocutaneous melanosis with pulmonary metastasis: looking beyond the skin

2019 ◽  
Vol 3 (2) ◽  
pp. 42-44
Author(s):  
Taseer Ahmed Bhatt
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Cord Compression ◽  
Melanocytic Nevus ◽  
Early Age ◽  
Congenital Melanocytic Nevus ◽  
Raised Intracranial Pressure ◽  
Neurocutaneous Melanosis ◽  
Central Nervous System Tumour ◽  
Giant Congenital Melanocytic Nevus

Neurocutaneous melanosis are neuroectodermal disorders characterized by giant congenital melanocytic nevus or multiple (≥3) nevus’s associated with melanocytic leptomeningeal tumour. Central nervous system tumour can be benign or malignant and usually presents at an early age. The neurological manifestation includes raised intracranial pressure, seizures and spinal cord compression. The dissemination of malignant nevomelanocytes to the peritoneal cavity has been observed with ventriculoperitoneal shunt placement in neurocutaneous melanosis. We report an infant of neurocutaneous melanosis with primary central nervous system melanoma and its metastasis to the lung in view of rarity.

scholarly journals Report of a case of Cobb syndrome: multimodality imaging

2020 ◽  
pp. 20200145
Author(s):  
Dalia Ibrahim ◽  
Shady Mashhour
Keyword(s):  
Upper Limb ◽  
Vascular Malformations ◽  
Multimodality Imaging ◽  
Skin Lesions ◽  
Cord Compression ◽  
Low Flow ◽  
Vascular Lesions ◽  
Cervical Cord ◽  
Limb Weakness ◽  
The Right

Cobb syndrome is a rare vascular disorder characterized by vascular skin lesions distributed in a dermatomal pattern, with corresponding muscular, osseous, paraspinal, and/or spinal vascular lesions occurring at the same body somite (metamere). We present a case of a 25-year-old man who presented with a history of right upper limb paresthesia followed by bilateral progressive upper and lower limb weakness and heaviness. Physical examination showed large cutaneous port wine stains on the right side of the chest, the nape, and along the whole right upper limb in a dermatomal distribution, with no corresponding limb hypertrophy or asymmetry. MRI and CT scan of the cervical spine showed aggressive vertebral hemangiomas involving the right side of C1 down to C4 vertebrae associated with extraosseous epidural lesion causing cervical cord compression, in addition to right paraspinal muscular low flow vascular malformations. Digital subtraction angiography of the neck vessels showed corresponding vascular blush and delayed contrast pooling in the affected regions. Cobb syndrome was diagnosed based on the dermatomal distribution of the cutaneous vascular lesions and the corresponding vertebral, epidural, and paraspinal vascular lesions occurring at the same metamere. The patient underwent a decompressive laminectomy at C2–C6 levels with removal of the epidural lesion, after which his symptoms had improved.

Sign in / Sign up

Export Citation Format

Share Document