RT Book, Section
A1 Gigante, Paul R.
A1 Hwang, Brian Y.
A1 Connolly, E. Sander
A2 Lee, Kiwon
SR Print(0)
ID 1101643879
T1 External Ventricular Drain Management and Ventriculoperitoneal Shunt
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=1101643879
RD 2024/04/20
AB A  56-year-old  woman  with  history  of  hypertension  and  hyperlipidemia  presented  with  a  sudden  onset  of  severe  headache  followed  by  nausea  and  vomiting.  She  was  taken  by  ambulance  to  the  nearby  emergency  department  (ED).  In  the  ED,  the  patient  was  alert  and  oriented  to  person,  place,  and  time  but  was  lethargic  and  uncooperative,  without  focal  neurologic  deficit.  Noncontrast  head  computed  tomographic  (CT)  scan  demonstrated  thick  hyperdensity  in  the  sylvian  and  interhemispheric  fissures,  as  well  as  in  the  basilar  cisterns.  Her  third  and  lateral  ventricles  were  notably  dilated.  She  was  diagnosed  with  subarachnoid  hemorrhage  (SAH)  with  evidence  of  early  hydrocephalus,  and  was  urgently  transferred  to  the  neurologic  intensive  care  unit  (NICU,  NeuroICU)  for  further  management.On  arrival  to  the  NICU  she  was  lethargic,  mumbling  incoherently,  not  following  commands,  pupils  were  symmetrically  reactive,  and  she  moved  all  extremities  with  good  strength.  Vital  signs:  heart  rate  88  bpm,  respiratory  rate  16  breaths/min,  temperature  37.4°C  (99.4°F),  blood  pressure  110/60  mm  Hg.  See  Figure  22-1.