TY - CHAP M1 - Book, Section TI - Multimodality Neuromonitoring A1 - Helbok, Raimund A1 - Kurtz, Pedro A1 - Claassen, Jan A2 - Lee, Kiwon PY - 2012 T2 - The NeuroICU Book 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. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - neurology.mhmedical.com/content.aspx?aid=1101643230 ER -