RT Book, Section
A1 Hanft, Simon
A1 Sisti, Michael B.
A2 Lee, Kiwon
SR Print(0)
ID 1143954620
T1 ICU Management of Brain Tumors
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=1143954620
RD 2024/04/18
AB A  52-year-old  woman  with  no  significant  past  medical  history  presents  with  a  headache;  she  had  a  subsequent  fall  without  loss  of  consciousness.  Over  the  next  few  days,  the  patient  continued  to  have  headaches  of  increasing  intensity.  On  the  day  of  admission,  she  complained  of  a  particularly  severe  headache,  which  preceded  another  fall.  It  was  at  this  time  that  the  patient  was  brought  to  a  nearby  emergency  department  (ED),  where  a  computerized  tomographic  (CT)  scan  of  the  head  revealed  a  large  space-occupying  lesion,  which  was  likely  a  parafalcine  meningioma.  The  patient  soon  developed  a  seizure  and  then  became  obtunded,  with  newly  documented  pupillary  asymmetry.  After  receiving  mannitol,  the  patient  was  transferred  to  a  neurologic  intensive  care  unit  (NeuroICU)  for  further  intervention.On  arrival  at  the  NeuroICU,  the  patient  was  intubated;  her  eyes  were  closed,  and  she  was  unable  to  follow  commands.  The  right  pupil  was  5  mm  and  nonreactive,  and  the  left  pupil  was  3  mm  and  reactive;  corneal  and  gag  reflexes  were  intact.  The  patient  was  able  to  briskly  localize  with  her  right  arm  and  leg,  whereas  her  left  arm  and  leg  were  flexing  to  painful  stimuli.  Vital  signs  on  admission  were  temperature,  99.7°F;  heart  rate,  91  bpm  in  sinus  rhythm;  and  blood  pressure,  120/67  mm  Hg  by  cuff  reading.  Mechanical  ventilation  was  set  to  assist  control–volume  control.