RT Book, Section
A1 Hanft, Simon
A1 Sisti, Michael B.
A2 Lee, Kiwon
SR Print(0)
ID 1101642836
T1 Intensive Care Unit (ICU) Management of Brain Tumors
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=1101642836
RD 2024/04/24
AB A  52-year-old  woman  with  no  significant  past  medical  history  presents  with  a  headache  and  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  ICU  for  further  intervention.On  arrival  at  the  neurologic  intensive  care  unit  (NICU),  the  patient  was  intubated  with  eyes  closed  and  unable  to  follow  commands.  The  right  pupil  was  5  mm  and  nonreactive,  while  the  left  pupil  was  3  mm  and  reactive;  corneal  and  gag  reflexes  were  intact.  The  patient  was  able  to  briskly  localize  with  the  right  arm  and  leg,  while  the  left  arm  and  leg  were  flexing  to  painful  stimuli.  Vital  signs  on  admission  were  temperature  of  99.7°F,  HR  91  bpm  in  sinus  rhythm,  blood  pressure  of  120/67  mm  Hg  by  cuff  reading,  and  mechanical  ventilation  set  to  assist  control–volume  control.