TY  - CHAP
M1  - Book, Section
TI  - Multimodality Neuromonitoring
A1  - Helbok, Raimund
A1  - Kurtz, Pedro
A1  - Claassen, Jan
A2  - Lee, Kiwon
PY  - 2017
T2  - The NeuroICU Book, 2e
AB  - A  34-year-old  right-handed  woman  with  a  history  of  smoking  presents  with  a  sudden  onset  of  severe  occipital  headache  followed  by  loss  of  consciousness  that  started  while  cleaning  her  bathroom.  In  the  emergency  department  she  is  found  to  be  arousable  to  deep  stimulation,  her  pupils  are  poorly  reactive  at  a  3-mm  diameter,  and  she  is  withdrawing  to  painful  stimulation  bilaterally.  When  her  mental  status  further  decline  she  is  intubated  for  airway  protection.  Head  computed  tomograpy  (CT)  scanning  (Figure  16-1)  reveals  a  subarachnoid  hemorrhage  (SAH),  with  thick  blood  filling  the  basal  cisterns,  hydrocephalus,  and  bilateral  intraventricular  hemorrhage  (IVH).  CT  angiography  reveals  an  aneurysm  of  the  anterior  communicating  artery  (ACoM).  She  is  transferred  to  the  nearest  tertiary  medical  care  center.Cerebral  angiography  reveals  an  8  ×  4-mm  ACoM  aneurysm  that  is  coiled  on  SAH  day  1  (Figure  16-2).  Additionally,  angiography  reveals  severe,  bilateral  anterior  cerebral  artery  vasospasm  that  improves  after  treatment  with  12  mg  of  intraarterial  (IA)  verapamil.  The  postprocedural  CT  scan  reveals  global  cerebral  edema  and  increasing  evidence  for  hydrocephalus.  An  external  ventricular  drainage  (EVD)  catheter  is  placed.  Postoperatively,  the  patient  is  found  to  be  in  coma  with  intact  brain  stem  reflexes,  bilateral  posturing  to  painful  stimulation,  and  bilateral  positive  Babinski  signs.  At  that  time,  the  treating  physicians  decides  to  place  a  multimodality  neuromonitoring  bundle  through  a  right  frontal  burr  whole  consisting  of  a  parenchymal  intracranial  pressure  (ICP)  monitor,  a  brain  tissue  oxygenation  probe,  and  an  MD  catheter.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - neurology.mhmedical.com/content.aspx?aid=1143955098
ER  -