Answer
Choice "E" is the best answer. The nature and timing of surgical intervention in subdural hemorrhage (SDH) depends upon multiple factors, including patient age and neurologic status. Imaging factors include size and location of the hematoma and signs of raised intracranial pressure, including the presence or absence of a midline shift. Emergency surgery does not guarantee a good outcome. Most neurosurgeons are even more reluctant to operate in a setting of impaired hemostasis. The role of surgical evacuation in a setting of anticoagulation has not been well defined.
Surgical evacuation via craniotomy is often considered in patients with an acute SDH thicker than 5 mm (as measured with axial computed tomography [CT]) and who have any neurologic signs, such as lethargy or other change in mental status, or a focal neurologic deficit. This patient has none of these findings, with a normal Glasgow score. Given the CT scan results showing stability, close observation is probably the most
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Control of blood pressure is especially important in intracranial hemorrhage, which is highly associated with hypertension. This patient has SDH and no elevation of his blood pressure.
Choice "B" is not the best answer. Craniectomy refers to the removal of a bone plate as part of the procedure. A craniectomy is used when there is raised intracranial pressure. If there is brain injury and edema, an intracranial pressure monitor should be placed.
Choice "C" is not the best answer. A large craniotomy over the thickest portion of the clot is the usual procedure used to decompress the brain in acute subdural hemorrhage. The Sylvian fissure is included in the exposure, if possible, as this is the most likely location of a ruptured cortical bridging vein, especially in trauma. A craniotomy is used to stop active bleeding and to evacuate any hematoma. The clot usually has a consistency that is too firm to allow removal through burr holes
How does this history of high blood pressure demonstrate the problem description and etiology components of the P.E.R.I.E. process? What different types of studies were used to establish etiology or contributory cause?
The first patient I saw was a 14 month old boy who sustained a non-accidental head injury. He underwent surgery in July that relieved the excess pressure and fluid around his brain, resulting in him becoming a left hemiplegic.
It is also placed for diagnostic evaluation of idiopathic normal pressure hydrocephalus according to Marmarou (2005). Hydrocephalus as defined by Sheppard & Wright (2006) is an abnormal increase in the volume of CSF within the brain. LDD placement is also used to reduce intracranial pressure (ICP) during craniotomy according to Grady et al (1999) and Samadani et al (2003) and as adjuvant therapy in the management of traumatically brain-injured patients added by Munch et al (2001). The knowledge gained from reading books and articles and the skills acquired and enhanced during the process of mentoring developed the confidence of the learner in looking after particular patient. To complete competency in this area and to advance knowledge and skills, it was suggested that learner have to increase exposure to particular patient group. This is experiential learning (learning by doing) recommended by Kolb (1984) where through repeated encounters thoughts are framed and modified. This support the advancement of the learner from ‘novice to expert’ (Benner, 1984) that occur as part of professional development.
A serious brain injury could lead to bleeding in or around your brain, causing symptoms that may develop right away or later.
Interaction with their patient on a regular basis is also a crucial aspect of a neurosurgeon’s career. Supporting the patient in medical decisions and informing the patient of all possible risks, effects, delays, results, and outcomes of his or hers surgery is conceivably the most imperative obligation a neurosurgeon can carry out. The physician must be able to clearly and precisely discuss they patient’s course of action with whom they are comfortable with to ensure the best recovery.
Injuries are a part of sports. They are inevitable, and impact athletes in a wide variety of sports. The movie, Bell Ringer: the Invisible Brain Injury, says the concussion has been gaining attention in the last few decades. The concussive injuries from sports have become a major issue currently being addressed by sports leagues everywhere. Frequently, athletes who sustain head injuries namely concussions are put right back into the game without further evaluation (Bell Ringer). Countless times the athlete does not need to go back in or has no reason going back into the game and could be at serious risk for another injury to the head. As an athlete gets concussed after the first head injury, the second one is usually way more serious than the
Computed tomography (CT) offers the advantages of 3D imaging with volumetric and multi-planar reconstructions (21, 22). Given the relatively high radiation doses involved, CT should not be used in place of conventional radiography, and should be restricted to critically ill children who may need neurosurgical intervention (21). Iterative reconstruction and all appropriate dose reduction techniques should be used to reduce radiation exposure (22).
Blood brain barrier breakdown is the central role of traumatic brain injury in the pathophysiology. Prevention of secondary damage following traumatic brain injury poses an important position in the treatment of traumatic brain injury or blood brain barrier breakdown.
Traumatic brain injury or TBI occurs when a child has a head injury that causes damage to the brain. These injuries can be caused from being hit in the head or violently shaken. The results of TBI can change how a person’s brain develops, how they act, move, and think. It can also affect how they learn in school (NICHCY, 2012). TBI can affect the way a child thinks, retains information, attention span, behavior, speech, physical activities (which includes walking), and the way a child learns.
There has yet to be a cure for Hydrocephalus, but there are indeed treatments. Although, not many advances have been made in preventing, healing, or moderating Hydrocephalus. In fact, the device currently used as the dominant treatment was pronounced fifty years ago and has had the highest failure rates in comparison to any surgical remedy. Introducing said regimen, The National Institute of Neurological Disorders and Stroke (2013) explains, “Hydrocephalus is most often treated by surgically inserting a shunt system.” This operation revolves around the embedding of two catheters along with a valve. The valve influences the flow of CSF to generate an increasingly normal rate and direction. As an alternative, there is a procedure labeled as a ventriculostomy in which a hole is made in the underlying area of a ventricle or in between the ventricles. This functions as a funnel for the CSF to exit the cranial area. These methods are customarily permanent and must be monitored
The surgery will usually take place once the baby has had a chance to adjust to its new environment, and can take place anywhere from within a few days to a few months after birth. The timing of the surgery is dependent upon the size and location of the encephalocele, the associated anomalies, and whether the deficit is skin—covered. The surgery will be performed sooner if there is: no skin covering over the defect, bleeding, airway obstruction, and/or vision impairment. The operation performed is called a ‘craniotomy’ and it involves the neurosurgeon cutting and removing a piece of bone from the child’s skull and then cutting through the membrane that protects the brain. This is necessary because the neurosurgeon has to replace the brain tissue, membranes, and/or fluids that have protruded from the gap in the skull, and remove the sac that was surrounding it. The neurosurgeon will finish the surgery by closing the dura mater and closing the skull with the same piece of bone that they had initially removed. Sometimes it may be necessary for a neurosurgeon to use an artificial plate to repair the skull if there is still a large
My objective in the long term is to provide therapeutic and counseling services that assist persons suffering with traumatic brain injury (TBI) or acquired brain injury (ABI) in coping and recovering from the mental illnesses that often accompany such tragedies. TBI/ABI has shown a proven link with “anxiety, depression, personality changes, aggression (National Alliance on Mental Illness Veterans Resource Center May 8, 2009 Traumatic Brain Injury)”, as well as many other issues. As the caregiver for a survivor of a rare and deadly strain of encephalitis, I have a personal perspective that I feel brings much to the discussion. I see the information I am currently gathering at Empire State College as the building blocks that pave the way to a thrilling career in a growing segment of the mental health industry. The CDC claims that approximately 1.4 million Americans suffer TBIs annually (Centers for Disease Control Injury Center May 30, 2007 Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths) and it has been called the “signature injury” of the current wars in Iraq & Afghanistan by the National Alliance on Mental Illness. As such, it is my belief that we need to focus time and energy on developing new programs to help these patients to cope with the new limitations and encourage rehabilitation and restoration.
So that, the diagnostic and therapeutic course of management should have been commenced sooner. Contacting other therapeutic members and explaining the situations to different people including nurse manager, consultant, senior registrar and anaesthetists have delayed the management. However, I believe that my action benefitted the patient and his family by avoiding further delay in the management. And also, ensuring the presence of a staff member with Michael’s wife should have assisted her to go through the unforeseen situation. I understand the neurological deterioration of GCS >8 and respiratory distress are indications of intubation of neuroscience patients. However, intubation is also indicated for therapeutic and diagnostic procedures in aggressive and uncooperative patients (Souter & Manno 2013). This scenario highlights the importance of the person-centred approach to clinical judgement and decision
Cerebral aneurysms are all different. They vary in shape, size, and location. Cerebral aneurysms are classified into three basic types based on their shape. These types are saccular, lateral, and fusiform (Zuccarello, 2016). Saccular aneurysms account for 90% of all aneurysm shape types (Buckley, 2016). This type forms a sac outside the artery that looks like a berry, therefore commonly referred to as a “berry aneurysm” (Brisman, 2014). It is attached by a neck of stem to an artery or a branch of a blood vessel. It is usually located on arteries at the base of the brain. A lateral aneurysm appears as a bulge on one
Schnall, P., Landsbergis, P., Belkic, K., Warren, K., Schwartz, J., & Pickering, T. (1998). Findings In The Cornell University Ambulatory Blood Pressure Worksite Study: A Review. Psychosomatic Medicine, 60, 697.