Acute Neurosurgical Emergency Research Articles

Cerebral abscess as a neurosurgical emergency in Eisenmenger syndrome: illustrative case.

Eisenmenger syndrome caused by severe pulmonary arterial hypertension in congenital heart disease can cause multisystemic involvement and is a risk factor for development of cerebral abscess. Cerebral abscess, if not detected and treated in a timely manner, can present as acute neurosurgical emergency. The authors reported a case of cerebral abscess in a patient with Eisenmenger syndrome. The patient presented with acute neurological deterioration with mass effect and cerebral infarcts and received emergency neurosurgical intervention. A further literature search was done to identify prior reported cases of cerebral abscess with Eisenmenger syndrome. Patients with Eisenmenger syndrome have compromised cardiorespiratory status, and decision for neurosurgical intervention should be given careful consideration. Multidisciplinary team management along with preoperative optimization of the patient should be used.

Idiopathic Spinal Subarachnoid and Subdural Hemorrhage in a Patient With Eosinophilic Granulomatosis and Polyangiitis

BACKGROUND AND IMPORTANCE: Development of concomitant spontaneous subdural hematoma (SSDH) and spontaneous subarachnoid hemorrhage (SSAH) in the spine without inciting trauma, iatrogenic event, or underlying cerebrovascular malformation is rare. It is rarer still for these to present in a patient with eosinophilic granulomatosus with polyangiitis. CLINICAL PRESENTATION: Herein, we present the case of a 73-year-old woman with a complex medical history, including possible eosinophilic granulomatosus with polyangiitis, who was admitted to the medical intensive care unit at Dartmouth-Hitchcock Medical Center and was found to have concominant SSAH and SSDH. CONCLUSION: This case serves as a review of the common and uncommon symptoms of IS-SAH with SSDH to improve recognition of this acute neurosurgical emergency in the medical intensive care setting.

10.4314/ajns.v9i2.70412

Pneumocephalus is a frequent complication following head injury and craniotomies. It can become an acute neurosurgical emergency when associated with raised intracranial pressure and neurological deterioration. Early diagnosis and timely appropriate intervention will reduce morbidity and unnecessary mortality from a case as this.

Development and evaluation of simulation based neurosurgery curriculum. Pilot study at the Poznan University of Medical Sciences.

Introduction. Neurosurgical emergencies are complex tasks. The current learning environment limits students’ ability to manage acute neurosurgical emergencies due to legal and safety concerns. Simulation provides an opportunity to participate in the care of neurosurgical emergencies and develop clinical decision making skills. Aim. We aim to determine whether neuroscience simulation curriculum improves student ability to: manage a critically ill patient, recognize neurosurgical emergencies, to assess how stress tolerance affects experience during simulations and effectiveness of students performance. The third objective is to develop a tool for student assessment.Material and Methods. The simulation was performed on SimMan 3G Human Patient Simulator (Laerdal Medical). Scenarios included common neurosurgical emergencies. Students were assessed before and after the course by completing a Likert type questionnaire. Response data was analysed using Cronbach’s reliability for Likert-type response data and Spearman's monotonic correlation. Results. 60 students of fifth and sixth year of medical studies attended the course. 39 students of them replied to the questionnaire. The simulated clinical experience was positive and it improved their knowledge about neurosurgical emergencies. There was an improvement in their confidence. Improvement in individual and team performance was also observed.Conclusions. Neurosurgical simulations improve students` ability to recognize neurosurgical emergencies. The level of stress related to simulation is important factor of the education process and should be reduced to improve students’ development. Our questionnaire is an effective tool for assessment of students experience during clinical simulations.

CSF S100B in patients treated by endovascular coiling or surgical clipping after aneurysmal subarachnoid hemorrhage and its correlation to cerebral vasospasm

BackgroundAneurysmal subarachnoid hemorrhage (aSAH) is an acute neurosurgical emergency with a significant fatality rate. In addition to acute brain injury, a considerable part of patients suffering from aSAH develops secondary brain damage such as cerebral vasospasm (CVS). CVS exacerbates the mortality. Therefore, it is urgently needed to find a biomarker, which could predict secondary brain and lead to operation by physicians more promptly. S100B, produced and released by astrocytes, has proven to be an important biomarker for brain injury.MethodsIn this present study, 51 patients with aSAH were included. Five CSF samples from each patient were obtained via lumbar puncture and were detected using electrochemiluminescence immunoassay (ECLIA).ResultsIt indicated that S100B had a higher concentration in CSF of patients treated by surgical clipping after aSAH than that treated with endovascular coiling. In addition, the mean CSF S100B level in patients without CVS was much lower compared with patients with CVS. And, the expression of S100B increased along with the Fisher Grade at the same day after aSAH attacked and decreased as time went on. Moreover, the CSF S100B level of different time points and the mean CSF S100B level can predict the risk of CVS.ConclusionsThese data suggest that CSF S100B can be served as a predictor of CVS, which triggers an immediate management by clinicians to prevent secondary exacerbation.

Penetrating skull fracture by a wooden object: Management dilemmas and literature review

Most penetrating skull injuries are caused by gun shot wounds or missiles. The compound depressed skull fracture represents an acute neurosurgical emergency. Management and diagnosis of such cases have been described, but its occurence following a fall onto a piece of wood is quite unusual. A 75-year-old female fell onto a piece of wood that penetrated her skull on the left frontal region and was treated in our department. The patient had no neurological deficits during presentation. She was managed surgically and removal of the wooden object was performed to prevent early or late infection complications. Wooden foreign bodies often pose a different set of challenges as far as penetrating injuries to the brain are concerned. Radiological difficulties and increased rates of infection due to its porous nature make these types of injuries particularly interesting. Their early diagnosis and appropriate treatment can minimize the risk of complications.

Who should transfer children with an acute neurosurgical emergency?

Should local anaesthetic teams be responsible for transfer of children with an acute neurosurgical emergency to a neurosurgical unit, or should specialized paediatric teams retrieve?

RANDOMIZED TRIAL ON IMPROVING INTER-HOSPITAL NEUROSURGICAL CONSULTATION BY TELE-RADIOLOGY

Neurosurgical service requires team work and highly specialized resources. Acute neurosurgical emergencies are traditionally referred from district general hospital (DGH) to the Neurosurgical Unit (NSU) by telephone consultation. Initial experience had proved that tele-radiology could improve diagnostic accuracy and reduce unnecessary transfer but clinical outcome improvement was not demonstrated.(1) We compare the traditional telephone consultation with tele-radiology. Patients with acute neurosurgical conditions in a DGH need consultation to NSU were included. These patients were divided into Head Injury, Stroke and Miscellaneous groups. They were further randomized to telephone or tele-radiology consultation mode in different groups. There were totally 375 patients recruited and randomized from the period between 1 October 1998 to 30 June 2000. The time requested for referral to decision made were 35 minutes and 60 minutes respectively, but similar in head injury subgroup. The total numbers of patient needed transfer to PWH were fewer in tele-radiology group (telephone: 80 vs. tele-radiology: 61). The diagnostic accuracy was also higher in tele-radiology group due to the visual aids from the transferred image. The overall outcome assessed on 6 months and showed that patients in tele-radiology group have better outcome score. In summary, this is a first randomized control study to confirm clinical benefits of tele-radiology on managing inter-hospital neurosurgical patients. (1) Does Teleradiology Improve Inter-hospital Management of Head-Injury. KYC Goh, KY Tsang and WS Poon, Can J Neurol Sci 1997; 24: 235–239.

Meningococcal meningitis with Arnold-Chiari malformation

A case of meningitis is reported which presented as an acute neurosurgical emergency in a patient with previously undiagnosed Arnold-Chiari malformation.

分娩中頭蓋内出血の１症例

Primary intraventricular hemorrhage (PIVH) is uncommon, especially during labor. The author's experience with PIVH leading to acute neurosurgical emergency during labor is discussed, and a recent diagnostic workup and treatment modalities are presented. A 32-year-old female was admitted to our institute with a headache, vomiting and loss of consciousness. A CT scan revealed large right cerebral hematoma and some hydrocephaly. After Caesarean section, the patient was transferred to the neurosurgical intensive care unit. Subsequent surgical management was successful and both mother and infant continued to do well with rehabilitation of speech and physical therapy two and a half years later. Increasing attention is being paid to acute neurosurgical conditions as new generation CT scanners have improved diagnosis and prognosis in corrective surgical management for central nervous disorders during labor.

Adrenocortical insufficiency and diffuse cerebral sclerosis: Problems of presentation and diagnosis

Three cases of adrenocortical insufficiency with diffuse cerebral sclerosis are described. One, which was confirmed by brain biopsy, had a family history of the combined disorder affecting members of a previous generation; this has not been previously reported; however pathological confirmation of the diagnosis in the earlier cases was not available. Two cases presented as acute neurosurgical emergencies and attention is drawn to this mode of presentation. Problems of aetiology, presentation and diagnosis are discussed and the finding of normal basal steroid levels is stressed.

Tension pneumocephalus - a rare but treatable cause of rapid neurological deterioration in traumatic brain injury. A case report

Pneumocephalus is a frequent complication following head injury and craniotomies. It can become an acute neurosurgical emergency when associated with raised intracranial pressure and neurological deterioration. Early diagnosis and timely appropriate intervention will reduce morbidity and unnecessary mortality from a case as this.