• Functional testing
○ N/A
• Procedures
○ Cerebral angiography 3
– General explanation
□ Radiographic procedure using injection of contrast medium to visualize vascular supply of the brain, including extracranial
– Indication
□ Suspected acute subarachnoid hemorrhage or intracranial aneurysm
□ Arteriovenous malformations
□ Cortical vein thrombosis
□ Dural sinus thrombosis
□ Vasculitis
– Contraindications
□ Coagulopathy
– Interpretation of results
□ Anatomic display of intracranial vasculature, allowing for planning of further therapy and surgical approach if necessary
○ Lumbar puncture 2
– General explanation
□ Sampling of cerebral spinal fluid for clinical suspicion of subarachnoid hemorrhage.
– Indication
□ Only indicated …show more content…
– Cerebrospinal fluid can show elevated protein and white blood cells with decreased glucose level
○ Migraine
– Patient will present with headache and photophobia
– Patient may also present with focal neurological deficits, such as visual disturbances
– Patient will likely have a history of migraine
– Computed tomography will not show evidence of blood in the cranial vault
○ Cerebral infarction
– Patient will present with similar neurological symptoms
– Computed tomography will not show evidence of blood in the cranial vault, except in hemorrhagic strokes
– Computed tomography will show evidence of damage to the brain parenchyma
TREATMENT
GOALS
• Provide relief of neurologic (i.e., seizures) and systemic signs of illness (i.e., vomiting)
• Maintain or improve physical function and quality of life, provide supportive care and palliation
• Prevent further neurologic impairment (i.e., hemiparesis) or permanent brain injury (i.e., …show more content…
DISPOSITION
• Admission criteria
○ Patient should be admitted to the ICU once airway is secure
○ Criteria for ICU admission
– All patients with a presumptive diagnosis of intracranial hemorrhage have adequate indication for ICU-level nursing, technical and medical/surgical care
• Recommendations for specialist referral
○ Neurosurgery
– A neurosurgery consult should be sought where operable intracranial hemorrhage is suspected (e.g., expanding subdural hematoma)
○ Neurology should be consulted routinely for intracranial hemorrhage
○ If mechanical ventilation is required, pulmonary medicine, or critical care specialist should be consulted
○ Rehabilitation therapist is indicated when the patient is stable enough to resume ambulation and physical activity
TREATMENT OPTIONS
•
○ Treatment is supportive with early emphasis on the cardiovascular system and a rapid assessment of neurologic status to facilitate decision-making
○ Airway, breathing and circulation are managed in the initial minutes of encounter: if ventilatory effort is compromised, intubation and initiation of mechanical ventilation is indicated
○ Intravenous fluids and pharmacologic therapy (i.e., pressor agents) to sustain adequate tissue perfusion at a mean arterial pressure of 110 mm Hg
○ N/A
• Procedures
○ Cerebral angiography 3
– General explanation
□ Radiographic procedure using injection of contrast medium to visualize vascular supply of the brain, including extracranial
– Indication
□ Suspected acute subarachnoid hemorrhage or intracranial aneurysm
□ Arteriovenous malformations
□ Cortical vein thrombosis
□ Dural sinus thrombosis
□ Vasculitis
– Contraindications
□ Coagulopathy
– Interpretation of results
□ Anatomic display of intracranial vasculature, allowing for planning of further therapy and surgical approach if necessary
○ Lumbar puncture 2
– General explanation
□ Sampling of cerebral spinal fluid for clinical suspicion of subarachnoid hemorrhage.
– Indication
□ Only indicated …show more content…
– Cerebrospinal fluid can show elevated protein and white blood cells with decreased glucose level
○ Migraine
– Patient will present with headache and photophobia
– Patient may also present with focal neurological deficits, such as visual disturbances
– Patient will likely have a history of migraine
– Computed tomography will not show evidence of blood in the cranial vault
○ Cerebral infarction
– Patient will present with similar neurological symptoms
– Computed tomography will not show evidence of blood in the cranial vault, except in hemorrhagic strokes
– Computed tomography will show evidence of damage to the brain parenchyma
TREATMENT
GOALS
• Provide relief of neurologic (i.e., seizures) and systemic signs of illness (i.e., vomiting)
• Maintain or improve physical function and quality of life, provide supportive care and palliation
• Prevent further neurologic impairment (i.e., hemiparesis) or permanent brain injury (i.e., …show more content…
DISPOSITION
• Admission criteria
○ Patient should be admitted to the ICU once airway is secure
○ Criteria for ICU admission
– All patients with a presumptive diagnosis of intracranial hemorrhage have adequate indication for ICU-level nursing, technical and medical/surgical care
• Recommendations for specialist referral
○ Neurosurgery
– A neurosurgery consult should be sought where operable intracranial hemorrhage is suspected (e.g., expanding subdural hematoma)
○ Neurology should be consulted routinely for intracranial hemorrhage
○ If mechanical ventilation is required, pulmonary medicine, or critical care specialist should be consulted
○ Rehabilitation therapist is indicated when the patient is stable enough to resume ambulation and physical activity
TREATMENT OPTIONS
•
○ Treatment is supportive with early emphasis on the cardiovascular system and a rapid assessment of neurologic status to facilitate decision-making
○ Airway, breathing and circulation are managed in the initial minutes of encounter: if ventilatory effort is compromised, intubation and initiation of mechanical ventilation is indicated
○ Intravenous fluids and pharmacologic therapy (i.e., pressor agents) to sustain adequate tissue perfusion at a mean arterial pressure of 110 mm Hg