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Intracranial Emergencies

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Intracranial Emergencies by Pip Boydell. Any progressive condition that may lead to permanent brain damage or death. Causative circumstances may include trauma, neoplasia, meningitis, seizures, hypoxia and cerebrovascular incidents, The cranium is an inflexible box, and any increase in the volume of its contents will lead to a build up of pressure. Many brain disorders lead to increase in volume of brain tissue, CSF or blood with consequent rise in intracranial pressure. This pressure will further damage brain tissue and may lead to shifting of certain brain components into adjacent compartments (anterior fossa, posterior fossa, cervical spine) with potential very severe adverse effects. Why is this presentation included under the broad term of neuro-ophthalmology? The status of the brain can be assessed clinically, to a significant extent, by inspection of pupil function and the state of the pupil may be a reasonably accurate measure of intracranial pressure in many situations. The typical response of the brain to insult (secondary injury) is oedema and consequent swelling and control of this response is vital. There are several mechanisms that may be used, the most important being the provision of suitable levels of oxygen, from oxygen tank through intranasal administration to artificial ventilation and even hyperbaric therapy. This may be accompanied by reducing the brain’s oxygen requirements with an induced coma. Continuous assessment requires blood gas analysis, routine anaesthetic monitoring parameters, intracranial pressure measurement etc and some form of critical care set up is required. When presented with such a neurologic emergency the specific diagnosis is less important than rapid stabilisation, the former being important for prognostic purposes but the latter being required for preservation of life prior to eg brain scanning. The use of corticosteroids to reduce cerebral oedema is generally contraindicated but ?? may be indicated in cases where access to suitable facilities or finances is limited?? Acute treatment of stroke in veterinary patients is rarely performed but a medical colleague informs me that knowledge of the intracranial/stroke emergency centre in one’s home town is a useful piece of data to store away.


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