Traumatic Brain Injury
Initial primary brain injury following trauma occurs immediately at the time of head impact and is largely irreversible. Public health measures such as airbags, seat belts, bike helmets, and fall…
Concussion
A. Concussion, more appropriately called mild traumatic brain injury, refers to any trauma-induced alteration in brain function. An obvious corollary of this is that patients must have head trauma causing…
Paroxysmal Sympathetic Hyperactivity
A. Paroxysmal sympathetic hyperactivity (PSH) is a syndrome encountered in patients with severe acute neurologic injury. Patients with PSH may have episodic tachycardia, hypertension, tachypnea, fever, diaphoresis, and posturing. Episodes…
Management of Neuromuscular Respiratory Failure
Patients with neuromuscular disease presenting with severe weakness require close monitoring of their respiratory status, as progression to respiratory failure can occur relatively suddenly. As the fundamental problem is one…
Management of Increased Intracranial Pressure
Brain tissue, cerebrospinal fluid (CSF), and blood are contained within the confined space of the skull. An increase in volume of one of these components necessarily results in a compensatory…
Brain Death
A. Brain death is defined, in the United States and many other countries, as permanent and irreversible cessation of whole brain function. Some countries, such as the United Kingdom, consider…
Cerebral Venous Sinus Thrombosis
Cerebral venous sinus thrombosis (CVST) presents with progressive headache, papilledema, changes in mental status, focal neurologic deficits, and/or seizures. Obstructed venous drainage causes venous congestion, resulting in cerebral edema, hemorrhage,…
Vascular Malformations
Vascular malformations of the brain can be organized into five subtypes: (1) cavernous malformations, (2) capillary telangiectasias, (3) arteriovenous malformations (AVMs), (4) developmental venous anomalies, and (5) dural arteriovenous fistulas…
Unruptured Intracranial Aneurysm
Management of unruptured intracranial aneurysms (UIAs) poses a conundrum to physicians. The prevalence of UIAs is approximately 3%, the majority of which are discovered incidentally. Rupture of an aneurysm can…
Subarachnoid Hemorrhage
Subarachnoid hemorrhage (SAH) refers to bleeding within the cerebrospinal fluid (CSF)-filled subarachnoid space. The majority of spontaneous cases are due to ruptured cerebral aneurysms, but 15%–20% are due to another…
