RT Book, Section
A1 Helbok, Raimund
A1 Kurtz, Pedro
A1 Claassen, Jan
A2 Lee, Kiwon
SR Print(0)
ID 1101643230
T1 Multimodality Neuromonitoring
T2 The NeuroICU Book
YR 2012
FD 2012
PB McGraw-Hill Education
PP New York, NY
SN 9780071636353
LK neurology.mhmedical.com/content.aspx?aid=1101643230
RD 2024/04/19
AB A  34-year-old  right-handed  woman  with  history  of  smoking  presented  with  a  sudden  onset  of  severe  occipital  headache  followed  by  loss  of  consciousness  that  started  while  cleaning  her  bathroom.  In  the  emergency  department,  she  was  found  to  be  arousable  to  deep  stimulation,  her  pupils  were  very  sluggish  and  almost  nonreactive  at  3-mm  diameter,  and  she  was  withdrawing  to  painful  stimulation  bilaterally.  When  her  mental  status  further  declined,  she  was  intubated  for  airway  protection.  Head  computerized  tomographic  (CT)  scanning  (Figure  14-1)  revealed  subarachnoid  hemorrhage  (SAH)  with  thick  blood  filling  the  basal  cisterns,  hydrocephalus,  and  bilateral  intraventricular  hemorrhage  (IVH).  CT  angiography  revealed  an  aneurysm  of  the  anterior  communicating  artery  (ACoM).  She  was  transferred  to  the  nearest  tertiary  medical  care  center.Cerebral  angiography  revealed  an  8  cm  ×  4  cm  ACoM  aneurysm  which  was  coiled  on  SAH  day  1  (Figure  14-2).  Additionally,  angiography  revealed  severe,  bilateral  anterior  cerebral  artery  vasospasm,  which  improved  after  treatment  with  12  mg  of  intra-arterial  (IA)  verapamil.  The  postprocedural  CT  scan  revealed  global  cerebral  edema  and  worsening  hydrocephalus.  An  external  ventricular  drainage  catheter  was  placed.  Postoperatively,  the  patient  was  found  to  be  in  coma  with  intact  brainstem  reflexes,  bilateral  posturing  to  painful  stimulation,  and  bilateral  positive  Babinski  signs.  At  that  time,  the  treating  physicians  decided  to  place  a  multimodality  neuromonitoring  bundle  through  a  right  frontal  burr  hole  consisting  of  a  parenchymal  intracranial  pressure  (ICP)  monitor,  a  brain  tissue  oxygenation  probe,  and  a  microdialysis  catheter.