0071643192.pdf

TREATMENT

■ Supportive therapy
■ Nimodipine: To prevent vasospasm and ischemic stroke
■ Antiemetics to prevent N/ V
■ Prophylactic phenytoin to prevent seizures
■ Sedation, as needed
■ Definitive therapy with endovascular coil embolization or surgical clipping

Meningitis

See“CNS Infections.”

Chronic Subdural Hematoma

Blood clot between the dura and the brain with symptom onset >2 weeks after
trauma (some patients report minor or no injury); seen more commonly in
patients with brain atrophy (elderly and alcoholics)

SYMPTOMS/EXAM

■ Headache
■ Unilateral weakness (up to half)
■ Altered consciousness, dementia

DIFFERENTIAL

■ Subdural hygroma: Collection of blood-tinged fluid in dural space of
uncertain etiology; tends to follow trauma; on CT fluid density is same as
CSF; surgical evaluation is needed, if symptomatic

DIAGNOSIS

■ Noncontrast CT scan: Isodense or hypodense material in subdural space
+/– mass effect (see Figure 15.5)
■ MRI scan: Will appear hyperdense

TREATMENT

■ Supportive therapy
■ Correct any coagulopathy, if present.
■ Immediate neurosurgical consultation for surgical evacuation

Brain Tumor

Headache is a common complaint in patients with brain tumor.

CAUSES

The most common cause is metastases from lung or breast carcinoma.

SYMPTOMS/EXAM

■ Worsening headache for weeks to months
■ May be worse upon awakening
■ The vast majority will have focal findings on detailed neurological
examination.

NEUROLOGY

Chronic subdurals appear

isodense or hypodense on

noncontrast CT.