Icp unequal pupil size1/2/2023 ![]() #ICP UNEQUAL PUPIL SIZE HOW TO#7Ĭlinical experience has matured over the years, but there are uncertainties about how to approach a patient with neuroimaging and clinical evidence of emerging brain swelling after an ischemic stroke. Decompressive craniectomy for cerebral edema after ischemic hemispheric stroke has significantly increased in US hospitals. 4, 6 Therefore, a decompressive craniectomy is offered to relieve the mass effect of the swollen hemisphere on the thalamus, brainstem, and network projections to the cortex, manifested mainly by a decreased level of arousal. There is a clinical perception that when brain swelling occurs in the cerebral or cerebellar hemisphere, medical management to reduce brain swelling is not successful in changing outcome. 2 – 5 Currently, no methods are available to predict the course of brain swelling reliably. The development of clinically significant cerebral edema is expected only in large-territory cerebral infarcts and can be observed by the clinician in 3 ways: a rapid and fulminant course (within 24–36 hours), a gradually progressive course (over several days), or an initially worsening course followed by a plateau and resolution (about a week). Unrelenting swelling disrupts the blood-brain barrier (BBB) therefore, a component of vasogenic edema may coexist. Brain swelling occurs as a result of loss of function of membrane transporters, causing sodium and water influx into the necrotic or ischemic cell, leading to cytotoxic edema. The emergence of brain swelling is the most troublesome and even life-threatening consequence of a large-territory ischemic stroke. Surgery after a cerebellar infarct leads to acceptable functional outcome in most patients. In swollen hemispheric supratentorial infarcts, outcome can be satisfactory, but one should anticipate that one third of patients will be severely disabled and fully dependent on care even after decompressive craniectomy. Ventriculostomy to relieve obstructive hydrocephalus after a cerebellar infarct should be accompanied by decompressive suboccipital craniectomy to avoid deterioration from upward cerebellar displacement. In swollen cerebellar stroke, suboccipital craniectomy with dural expansion should be performed in patients who deteriorate neurologically. There is uncertainty about the efficacy of decompressive craniectomy in patients ≥60 years of age. In swollen supratentorial hemispheric ischemic stroke, routine intracranial pressure monitoring or cerebrospinal fluid diversion is not indicated, but decompressive craniectomy with dural expansion should be considered in patients who continue to deteriorate neurologically. ![]() Complex medical care includes airway management and mechanical ventilation, blood pressure control, fluid management, and glucose and temperature control. These patients are best admitted to intensive care or stroke units attended by skilled and experienced physicians such as neurointensivists or vascular neurologists. #ICP UNEQUAL PUPIL SIZE FULL#If a full resuscitative status is warranted in a patient with a large territorial stroke, admission to a unit with neurological monitoring capabilities is needed. Identification of patients at high risk for brain swelling should include clinical and neuroimaging data. ![]() Standardized definitions should be established to facilitate multicenter and population-based studies of incidence, prevalence, risk factors, and outcomes. In swollen cerebellar infarction, a decrease in level of consciousness occurs as a result of brainstem compression and therefore may include early loss of corneal reflexes and the development of miosis. Clinical signs that signify deterioration in swollen supratentorial hemispheric ischemic stroke include new or further impairment of consciousness, cerebral ptosis, and changes in pupillary size. Customer Service and Ordering InformationĬlinical criteria are available for hemispheric (involving the entire middle cerebral artery territory or more) and cerebellar (involving the posterior inferior cerebellar artery or superior cerebellar artery) swelling caused by ischemic infarction.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB). ![]()
0 Comments
Leave a Reply.AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |