Download PDF by M. Brandon Westover, M.D. Ph.D., David M. Greer, Emily Choi,: Pocket Neurology

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8°F) is reached â first discontinue paralytic, then sedative once pt demonstrates motor activity or once train of 4 is achieved on monitor. Rewarming after cooling blankets ± ice: Remove cooling blankets (& ice if still in use). • 5. 6°F) for the next 48 h (72 h total). 40 TRAUMATIC BRAIN INJURY Classification: Mild TBI: GCS 13-15 (see GCS definition at start of chapter). Moderate TBI: GCS 9-12. Severe TBI: GCS 3-8. 5 million cases of TBI per year in the United States; 230,000 hospital admissions; 50,000 mortalities; 80,000 w/ long-term disabilities.

Current guidelines: CAS for high risk surgical pts w/ stenosis > 70% & sx. Extracranial/intracranial bypass: Used in carotid occlusion: superior temporal artery anastomosed to MCA. 1985 International EC/IC bypass: no benefit (Stroke 1985;16:397). (Criticism: pts w/ completed infarctions included, no perfusion studies). , complete stenosis). Misery perfusion tested via: Acetazolamide challenge: pre-postacetazolamide images taken (MR or CT), Rx dilates vessels & â s CBF, vessels already max dilated will show little/no â blood flow.

Craniotomy. Observation for small hematoma (<10 mm thickness, no herniation shift < 5 mm), repeat CT in 6-8 h, then serially. Chronic SDH: Trauma: Trivial or forgotten. Days-weeks of HA, AMS, encephalopathy. CT: Clot iso â hypodense (in about 1/mo). MR: Hyper (weeks) â hypointense (months) on T1. Rx: Small SDH: Observation. Large SDH (â ¥10 mm thick, â ¥5 mm shift) or sx: surgery. Burr hole w/ catheter placement à several days until clot drained. Craniotomy if rebleed after burr. Epidural hemorrhage: Middle meningeal a.

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