TY - CHAP M1 - Book, Section TI - External Ventricular Drain Management and Ventriculoperitoneal Shunt A1 - Gigante, Paul R. A1 - Hwang, Brian Y. A1 - Connolly, E. Sander A2 - Lee, Kiwon Y1 - 2012 N1 - T2 - The NeuroICU Book 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. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/04/23 UR - neurology.mhmedical.com/content.aspx?aid=1101643879 ER -