Stupor After Brain Surgery
FIGURE 16.1 A) MRI shows large ependymona in the 4th ventricle. B) CT scan about 10 days after surgery shows multiple hypodensities. C) The cerebral angiogram (sample of multiple series)…
NEUROSURGERY
Failure to Awaken After Surgery
FIGURE 15.1 CT scan shows bilateral cerebellar hypodensities with acute obstructive hydrocephalus. What do you do now? Without doubt, abnormal wakefulness after a surgical procedure is the most common reason…
Hypothermia After Cardiopulmonary Resuscitation
13 Hypothermia After Cardiopulmonary Resuscitation A 61-year-old woman slumped down with rattling breathing and rapidly developing cyanosis. A bystander performed cardiopulmonary resuscitation, but the EMS arrived quickly and documented ventricular…
Neurological Worsening After Subarachnoid Hemorrhage
FIGURE 9.1 A) Initial head CT scan showing SAH with aneurysmal pattern and some blood layering in the lateral ventricles consistent with a modified Fisher scale grade 4. B) Follow-up…
Deteriorioration from Brain Metastasis
FIGURE 12.1 A) Head CT scan showing a left cerebellar mass with associated edema producing effacement of the 4th ventricle. B) At a higher level, a second mass is seen…
Sorting Out and Treating Encephalitis
FIGURE 5.1 Brain imaging in our patient with acute HSV-1 encephalitis. CT scan (A and B) showing low attenuation changes in the right temporal lobe and right insular region. Notice…
Medical Care of Traumatic Brain Injury
FIGURE 3.1 Early CT scan after traumatic brain injury showing major contusional lesions and subdural hematomas with mass effect. Third issue: There are often major confounders—as it is alcohol intoxication…
Options in Acute Spinal Cord Compression
FIGURE 10.1 Large T7 lesion compressing the cord. Cancer can take a significant and profound turn for the worse with spinal cord compression. Spinal cord compression may be a presenting…
Reversal of Anticoagulation After Cerebral Hemorrhage
FIGURE 2.1 Serial CT scans show expansion of the thalamic hematoma and development of acute hydrocephalus. Ongoing anticoagulation in a patient with a cerebral hematoma is a serious concern. As…
Fulminant Bacterial Meningitis
FIGURE 4.1 CT scans shows early hydrocephalus (A) MRI shows dramatic meningeal enhancement. (B) Also, evidence of restricted diffusion in bilateral frontal temporal cortex indicative of additional laminar cortical necrosis…
