NEUROSURGICAL EMERGENCIES
Magued Bahgat Samy;
Abstract
Most neurosurgical emergencies are a consequence of central nervous system (CNS) trauma. Other etiologies such as a ruptured intracranial aneurysm, obstructing intracranial tumor, spinal cord tumor, or congenital malformation may require urgent neurosurgical care.
Neurosurgical.emergencies include a wide variety of procedures, ranging from the pediatric patient to the adult. Since the most frequent cause of a neurosurgical emergency is CNS trauma, a major goal in these patients is to prevent further injury from secondary insults.
Clinical care of CNS trauma patient starts with prompt attention to airway and ventilation as well as maintenance of adequate brain and spinal cord perfusion. Early hypoxaemia without neurogenic pulmonary edema occurs in more than 50% of severely head-injured patients, although in survivors it is usually transient and mild.
Developments in monitoring technology, in concert with our rapidly growing understanding of the function and malfunction of the central nervous system, offer exciting new ways of monitoring the brain and spinal cord. Many of these methods are still experimental, but some provide important information that may well have a dramatic effect on the outcome of patient care in the operating room and critical care unit. Nevertheless, clinical assessment of the awake patient, when this is possible and reasonable, is still the most important technique available for monitoring the central nervous system.
In all patients presenting for emergent neurosurgical care, it is important to recognize systemic as well as neurologic complications of injury to optimize the probability of a good patient outcome.
The outcome of CNS trauma patients is affected by the amount of primary and secondary CNS injury that has been sustained. The first, or primary injury, occurs at the time of .mechanical trauma, while the secondary injury is mediated by microvascular and subsequent biochemical forces that are set in motion by the injury.
Neurosurgical.emergencies include a wide variety of procedures, ranging from the pediatric patient to the adult. Since the most frequent cause of a neurosurgical emergency is CNS trauma, a major goal in these patients is to prevent further injury from secondary insults.
Clinical care of CNS trauma patient starts with prompt attention to airway and ventilation as well as maintenance of adequate brain and spinal cord perfusion. Early hypoxaemia without neurogenic pulmonary edema occurs in more than 50% of severely head-injured patients, although in survivors it is usually transient and mild.
Developments in monitoring technology, in concert with our rapidly growing understanding of the function and malfunction of the central nervous system, offer exciting new ways of monitoring the brain and spinal cord. Many of these methods are still experimental, but some provide important information that may well have a dramatic effect on the outcome of patient care in the operating room and critical care unit. Nevertheless, clinical assessment of the awake patient, when this is possible and reasonable, is still the most important technique available for monitoring the central nervous system.
In all patients presenting for emergent neurosurgical care, it is important to recognize systemic as well as neurologic complications of injury to optimize the probability of a good patient outcome.
The outcome of CNS trauma patients is affected by the amount of primary and secondary CNS injury that has been sustained. The first, or primary injury, occurs at the time of .mechanical trauma, while the secondary injury is mediated by microvascular and subsequent biochemical forces that are set in motion by the injury.
Other data
| Title | NEUROSURGICAL EMERGENCIES | Other Titles | جراحات حالات المخ والأعصاب الحرجة | Authors | Magued Bahgat Samy | Issue Date | 2000 |
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