RT Book, Section
A1 Alexiades, Nikita G.
A1 Ellis, Jason A.
A1 Connolly, Jr., E. Sander
A2 Lee, Kiwon
SR Print(0)
ID 1143955479
T1 External Ventricular Drain Management and Ventriculoperitoneal Shunts
T2 The NeuroICU Book, 2e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071841443
LK neurology.mhmedical.com/content.aspx?aid=1143955479
RD 2024/04/19
AB A  64-year-old  woman  with  a  history  of  hypertension  and  hyperlipidemia  presents  with  sudden  onset  headache  and  stupor.  She  is  taken  by  ambulance  to  a  nearby  emergency  department  (ED);  en  route  she  is  given  2  mg  midazolam  because  of  seizure-like  activity.  In  the  ED,  the  patient  is  minimally  responsive  to  pain  with  a  flaccid  right  arm  and  increased  tone  in  her  lower  extremities  and  is  subsequently  intubated.  Noncontrast  head  computed  tomography  (CT)  demonstrates  hyperdensity  in  the  sylvian  fissure  and  basilar  cisterns  and  intraventricular  hemorrhage  (IVH).  Her  third  and  lateral  ventricles  are  notably  dilated.  She  is  diagnosed  with  subarachnoid  hemorrhage  (SAH)  with  IVH  and  early  hydrocephalus  and  is  transferred  to  the  neurologic  intensive  care  unit  (NeuroICU)  for  further  management.On  arrival  to  the  NeuroICU  she  is  examined  with  no  sedation  and  is  found  to  not  follow  commands.  Her  pupils  are  symmetrically  reactive,  and  she  moves  her  left  side  purposefully  but  is  flaccid  in  her  right  upper  extremity.  Vital  signs  are  heart  rate,  90  bpm;  respiratory  rate,  18  breaths  per  minute;  temperature,  37.4°C  (99.4°F);  and  blood  pressure,  120/73  mm  Hg  (Figure  22-1).