Articles: external-ventricular-drains.
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Clin Neurol Neurosurg · Nov 2013
Observational StudyIncreased ventriculostomy infection rate with use of intraventricular tissue plasminogen activator: a single-center observation.
Intraventricular tissue plasminogen activator (alteplase) has been advocated for prevention of vasospasm in aneurysmal subarachnoid hemorrhage and treatment of traumatic or spontaneous intraventricular hemorrhage. External ventricular drain (EVD) insertion is often performed to manage increased intracranial pressure and hydrocephalus associated with these disease states. EVD-related ventriculitis is a serious infection with an up to 50% mortality rate. ⋯ Intraventricular alteplase use may increase ventriculitis risk. Currently, we reserve intraventricular alteplase for patients with EVDs obstructed by hematoma accompanied by increased intracranial pressure.
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An infection of the ventricular system of the brain is referred to as ventriculitis. The signs and symptoms of ventriculitis include the triad of altered mental status, fever, and headache, as seen in the patient with meningitis. Identifying the organism responsible is important in determining the cause and in planning a treatment strategy. Nurses have a pivotal role in the early identification and management of the patient with ventriculitis.
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Cerebral metastases are a common neurosurgical finding. Surgery confers several advantages to other therapies, including immediate symptomatic improvement, diagnosis, and relief from corticosteroid dependence. Here we evaluate patients with cerebellar metastases who underwent surgery and compare their findings to those in the literature, and address the benefit of avoiding ventriculo-peritoneal shunting in patients undergoing surgery. ⋯ A review of the literature has shown a high complication rate in patients undergoing surgical resection of cerebellar metastases. We have shown that surgical resection of cerebellar metastases is a safe procedure and is effective in the treatment of hydrocephalus in the majority of patients harboring cerebellar lesions.