By Senior Registrar Department of Anaesthesia Nian Chih Hwang, Peng Jin London Lucien Ooi
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Extra info for Acute Surgical Management
The time-tested conventional method is to insert a Paediatric Neurosurgical Emergencies Fig. 4 47 Axial CT scan of the brain showing large lateral ventricles. Fig. 5 Axial CT scan of the brain showing a large rounded third ventricle in addition to large frontal and temporal horns of the lateral ventricles. shunt, with the safest being the ventriculo-peritoneal (VP) shunt. In this operation, a small-calibre silicon tubing is inserted into the ventricle, connected to a flow- or pressure-regulated valve, and then subcutaneously tunnelled to the abdomen where it is inserted into the peritoneal 48 KYC Goh Fig.
This chapter will discuss spontaneous, non-traumatic haemorrhages (Table 1)1 within the brain parenchyma (ICH proper). Initial Clinical Approach to the Patient The common situation is when the patient is brought to the emergency department for symptoms suggestive of stroke that is, with sudden neurologic deficit. Patients with ICH may also present with headaches, seizures, confusion or drowsiness. Apart from the common ABC’s of resuscitation, the first clinical assessment should include the following parameters: (1) (2) (3) (4) Glasgow Coma Score (GCS).
Bleeding occurs into the potential space between the dura and the skull. This may take time to occur, and a lucid interval may be found, before clinical deterioration occurs. Because the pathology is essentially outside the brain, the prognosis is good provided the haematoma is evacuated soon enough. Acute subdural haematomas Bleeding occurs into the subdural space, lying between the dura and the arachnoid. This can occur in two circumstances: (1) Bleeding from a torn bridging vein, especially in the elderly.
Acute Surgical Management by Senior Registrar Department of Anaesthesia Nian Chih Hwang, Peng Jin London Lucien Ooi
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