i12866 [Neurosurgery Wiki]

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===== i12866 =====


A 33-year-old [[woman]] admitted to the [[ICU]] due to [[intraventricular hemorrhage]]. An [[arteriography]] is performed where an [[abnormal]] venous drainage is appreciated and an [[MRI]] is performed where signs of [[venous thrombosis]] are ruled out.
The patient was going to be [[discharge]]d to the Neurosurgery [[ward]] with [[GCS]] 15 points, without focality. [[Headache]] poorly controlled with conventional [[analgesia]]. He did have significant [[stiffness]] in the [[neck]]. [[Nausea]] with improvement after administration of [[granisetron]]. Throughout the afternoon, neurological deterioration began until a GCS of 10 points (O2V3M5), we performed a brain [[CT]] in which a significant increase in the [[hydrocephalus]] component was observed compared to previous [[neuroimaging]]. Neurosurgery is contacted, deciding to implant [[EVD]]

She woke up without focality and was extubated without [[incident]].

She remains conscious and oriented, with better [[pain]] control, without apparent focality. GCS: 15 points (M: 6, O: 3, V: 5). It maintains hemodynamic [[stability]], diuresis and renal function. EVD at 18 cm H2O with output of 140 cc of CSF with a stained serous appearance. PiC and PPC in range. Control CT slope.

Restarted oral diet with excellent tolerance. I request a control test with an increase in CRP to 5 mg/dL. Normal rest. Good gas exchange. CSF [[culture]] taken today. Strictly normal arterial blood gases. Eupneic to room air.