Surg Neurol
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Review Case Reports
Cerebral aneurysm rupture after r-TPA thrombolysis for acute myocardial infarction.
Intracranial hemorrhage is the most dreaded risk of thrombolytic therapy for acute myocardial infarction because of the high mortality and disability rates associated with this complication. Brain structural lesions may predispose a patient to bleeding. To date, aneurysm rupture has not been described as a complication of such therapy. ⋯ Cerebral aneurysms should be considered as a possible contributing factor to intracranial bleeding after thrombolytic therapy.
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Review Case Reports
Intradural extension of mucocele complicating frontoethmoid sinus osteoma: case report.
Osteomas of the paranasal sinus are often asymptomatic and are sometimes complicated by mucoceles, but intradural extension of such a mucocele has rarely been reported. ⋯ The importance of radical surgery for such lesions and the relationship between osteomas and mucoceles are discussed.
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Acute hydrocephalus as a consequence of subarachnoid hemorrhage is a relatively frequent problem. It is associated with more neurologic impairment and mortality than subarachnoid hemorrhage without hydrocephalus. A review of the literature was done to determine its frequency of presentation, the associated causes of morbidity and mortality, its clinical presentation, and treatment options. ⋯ If a patient presents with subarachnoid hemorrhage accompanied by acute hydrocephalus and preserved level of consciousness, he/she should be carefully observed for the first 24 h. If deterioration of consciousness ensues and is not attributable to rebleeding or metabolic causes, ventriculostomy should be performed. If a patient presents with subarachnoid hemorrhage accompanied by acute hydrocephalus and depressed level of consciousness ventriculostomy should be immediately placed. After ventriculostomy, intracranial pressure should be maintained above 15 mm Hg to prevent rebleeding. Prophylactic antibiotics and long subcutaneous catheters should be used to avoid shunt infections.
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The long-term administration of neuromuscular blocking (NMB) agents in the ICU has increased in frequency the last several years. NMB agents in the ICU patient facilitate intubation and ventilatory support, decrease oxygen demand and consumption, facilitate bedside procedures and diagnostics, and potentially decrease intracranial pressure. However, NMB agents have extensive adverse effect profiles and require close monitoring. ⋯ Nondepolarizing NMB agents induce muscle paralysis by their competitive antagonism at the nicotinic cholinergic receptor. The neurosurgeon must be aware that NMB agents are paralytics only and should only be used in patients who are sedated and receiving adequate analgesia. Appropriate drug selection demands a thorough knowledge and understanding of each patient's neurologic, metabolic, and cardiovascular status and the hemodynamic, autonomic, pharmacokinetic, pharmacodynamic, and cost profiles of the NMB agents.