A 9 year old boy fell while trampolining and struck his head on the trampoline frame. There was definite loss of consciousness but just for how long is unclear as the only witnesses were friends his age. The clinical image shows findings on the left side of his head.
Alistair Nichol explains why the "favourability" of outcomes from brain trauma in the RESCUEicp trial are in the eye of the beholder.
According to an editorial in the NEJM, decompressive craniectomy "has a proven benefit in the management of malignant cerebral edema after ischemic stroke”... We point out the caveats to this assertion.
Spinal epidural abscess is considered a neurosurgical emergency; morbidity and mortality is worse with delayed diagnosis, and the worse the neurological deficit at the time of surgery the worse the outcome
Decompressive craniectomy is a controversial therapy for malignant middle cerebral artery (MCA) stroke
Decompressive Craniectomy: can be prophylactic or therapeutic; increases intracranial compliance and prevents/treats elevated ICP (especially if dura opened)
Monitoring in the critically ill subarachnoid haemorrhage patient is primarily to detect vasospasm.
Neurosurgery Literature Summaries
SAH Complications including Neurological deterioration; Seizures; Hyponatremia; Cardiac complications; Re-bleeding; Vasospasm
Subarachnoid Haemorrhage Grading Systems: GCS; Hunt and Hess; WFNS; Fisher; Claassen; Ogilvy and Carter
SAH ICU Management: Follows initial management of SAH; FASTS HUGS IN BED Please applies; certain aspects have particular relevance