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2 results

  • Chapter 14 - Emergency Prescribing in Neurosurgery

  • from Part 3 - Emergency Prescribing
  • Edited by Hugh Montgomery, Robert Shulman, Mayur Murali
  • Book:
    Surviving Prescribing
    Published online:
    08 June 2020
    Print publication:
    25 June 2020, pp 57-60

  • Summary

    While the neurosurgical patient is not normally one junior prescribers should be caring for in a nonspecialist area, they may encounter them in the acute setting while a referral is being made. Readers are provided with key information on the management of subarachnoid haemorrhage, including how to manage blood pressure, prevent vasospasm and rebleeding. Adjuncts to reduce the chances of secondary brain injury, including steroids, mannitol and anticonvulsants, are also discussed, while the importance of good quality analgesia is also emphasised.

  • Case 96 - Guillain-Barrésyndrome

  • from Section II - Neurocritical care
  • Edited by George A. Mashour, Ehab Farag
  • Book:
    Case Studies in Neuroanesthesia and Neurocritical Care
    Published online:
    03 May 2011
    Print publication:
    03 February 2011, pp 324-326

  • Summary

    Subarachnoid hemorrhage (SAH) represents bleeding into the subarachnoid space, most commonly from a ruptured cerebral aneurysm. This chapter presents a case study of a 52-year-old right-handed female with a medical history of smoking and hypertension who developed an abrupt onset of a severe bifrontal headache. The development of the operative microscope and interventional procedures has allowed for the early treatment of cerebral aneurysms to prevent rebleeding. Rebleeding occurs within the first few weeks of the initial hemorrhage in one-third of patients with SAH and acutely worsens outcomes. Treatment of patients with SAH, once an aneurysm is secured, includes generous use of intravenous isotonic fluids. Clinical studies have suggested that a majority of neurologic deficits can be reversed with the application of the hemodynamic techniques. The application of interventions for vasospasm may be guided by noninvasive measures of vessel narrowing and cerebral blood flow.