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Emergency and critical care neurology - Practice: Part 2

(BQ) Continued part 1, part 2 of the document Emergency and critical care neurology - Practice has contents: Management of specific disorders in critical care neurology, management of systemic complications, postoperative neurosurgical and neurointerventional complications, formulas and scales,. and other contents. Invite you to refer. | PART VII Management of Specific Disorders in Critical Care Neurology http internalmedicinebook.com http internalmedicinebook.com 26 Aneurysmal Subarachnoid Hemorrhage Major medical institutions may admit 50-75 patients with an aneurysmal subarachnoid hemorrhage SAH a year. A multidisciplinary team is required to respond to the immediate needs of the patient and to plan for repair of the aneurysm.8 42 101 154 175 Expertise may prevent poor outcome.25 47 133 After aneurysmal rupture 10 of patients die suddenly or within the first hours before ever receiving adequate medical attention. Many of these patients had marked intraventricular extension of the hemorrhage and acute pulmonary edema both reasons for sudden death.144 Of those most severely affected who reach the emergency department ED or neurosciences intensive care unit NICU half die within 3 months. Some of these patients may have been found pulseless and required prolonged cardiopulmonary resuscitation. Patients who survive a major first rupture face the immediate risk of catastrophic rebleeding rapidly developing hydrocephalus potentially hlifre-att ening pulmonary edema and cardiac arrhythmias. Presentation in a poor clinical condition often indicates that the hemorrhage is not confined to the subarachnoid space but rather there is intraventricular and intraparenchymal extension. Many have additional large ventricles and are in need of CSF diversion with a ventriculostomy. The critical steps in managing SAH are to surgically clip the aneurysm or occlude the sac by inserting platinum coils to treat clinical neurologic deterioration early and to manage major systemic complications.169 Aneurysmal subarachnoid hemorrhage is a prime example of a neurocritical and neurosurgical disorder where outcome in the first days after presentation cannot be judged adequately and care of the initially comatose patient can lead to a satisfactory outcome. Fortunately a considerable proportion of patients with SAH present with