728x90 신경외과56 Brain injury, hemorrhage Op indication Management Options for Traumatic Hemorrhagic Lesions Condition Management Subdural Hematoma >10 mm thick or >5 mm midline shift Surgical evacuation ICP >20 mm Hg Surgical evacuation GCS score 30 mL volume, regardless of GCS score Surgical evacuation GCS score >8 without focal neurological deficit Conservative management with intensive monitoring and serial imaging Intraparenchymal Hematoma Progr.. 2020. 12. 31. Spinal cord injury Assessment of cervical spine after Trauma 1. 역학 1) SCI (young, predominantly male), 10~20% of cervical fx result in SCI 2) MVA : 35~45% of all SCI ( m/c in C spine ), Fall : m/c cause of C spine & SCI in Elderly 3) Ped spine trauma – different levels according to age – 18세 이상(3/4 below C4), 8세 미만 (70% C3이상) 4) Primary reason for the difference in injury pattern – young children (relatively large.. 2020. 12. 29. A-com aneurysm 관련.. thejns.org/view/journals/j-neurosurg/132/5/article-p1517.xml Anatomical triangles defining routes to anterior communicating artery aneurysms: the junctional and precommunicating triangles a OBJECTIVE Anterior communicating artery (ACoA) aneurysms are common intracranial aneurysms. Despite advances in endovascular therapy, microsur thejns.org The direction of A-com aneurysm neck Anterior(22.7%) :.. 2020. 12. 28. 외상환자 관련 0) 초진환자 응급실 내원환자 전신 손상의심(자전거, 오토바이, 추락 등) -> 반드시 흉부, 복부 검사 시행 CT (Chest, Abdomen-pevis) X-ray (Chest, Abdomen, Pelvis) 의식저하나 중증환자의 경우 가급적 T_bay로 이동 의식이 명료한 경우 (특히 chronic SDH) NPO time확인 T-bay 내원환자 외상보다 의식소실이 먼저인게 확인된 경우 -> CT angio GCS < 9, 개방성 뇌손상, 두개골 기저부의 심한손상시 (또는 심한 안면 손상) CT angio 1) 초기 외상 소생술 Airway – Intubation 이 필요하다고 판단되면, 즉시 시행. A-line이나 C-line이 먼저가 아님. Vital sign 유지 – 혈압이 높다고 급하게 낮추.. 2020. 11. 27. Antithrombotic Agents 1. anticoagulants Warfarin reversal Heparin 2. Antiplatelets # Unruptured aneurysm 의 endovascular treatment 시술 전 : aspirin 100mg 1T Qd + Clopidogrel 75mg 1T Qd x 5-7 days # Loading) aspirin 100mg 3T + clopidogrel 4T (둘 다 300mg) 3. Fibrinolytics a. Streptokinase, Anistreplase b. Urokinase c. t-PA (tissue Plasminogen Activator), Alteplase, Reteplase, Tenecteplase 2020. 11. 24. Occlusive cerebro-vascular disease 1) Carotid stenosis a. Workup - Carotid doppler /coronary angiography - CT angiography including carotid - brain MRI+A including carotid - brain SPECT (Diamox study, if indicated) b. Postoperative management 1. strict BP control!! : 수술 후 1주간, 특히 POD~2일째 까지의 혈압조절은 critical! A. SBP 2020. 11. 24. Intracerebral hemorrhage Spontaneous supratentorial ICH Pathophysiology 1. Cause 1) Hypertension 2) Amyloid angiopathy (m/c cause of lobar hemorrhage in elderly) Current Guidelines The AHA/ASA (2015) 1. cerebellar hemorrhage A. Neurological deterioration or brainstem compression and/or hydrocephalus: 가능한 빨리 surgical removal of the hemorrhage, Initial treatment of these patients with ventricular drainage rather than surg.. 2020. 11. 24. Vascular malformations 1) AVM Spetzler-Martin AVM Grading Scale Points Size (cm) 0-3 1 3-6 2 >6 3 Location Non-eloquent 0 Eloquent 1 Deep venous drainage (-) 0 (+) 1 AVM total score 1-5 l The lower the score, the better the outcome l Eloquent locations : areas of sensorimotor, language, visual, thalamus, hypothalamus, internal capsule, brain stem, cerebellar peduncles, and deep cerebellar nuclei l Size: largest diamet.. 2020. 11. 24. Subarachnoid hemorrhage (SAH) 1) 기본적인 grade Hunt Hess Grade: a predictor of a patient's prognosis/outcome Grade Characteristics Mortality Rate (%) 0 Unruptured aneurysm without symptoms 0 1 Asymptomatic or minimal headache and slight nuchal rigidity 1 1a No acute meningeal or brain reaction but with fixed neurologic deficit 1 2 Moderate to severe headache, nuchal rigidity, no neurologic deficit other than cranial nerve palsy.. 2020. 11. 24. 이전 1 ··· 3 4 5 6 7 다음 728x90
