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 2024/10/11 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.