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This book reviews the common clinical scenarios that might trigger emergent consultation for neurosurgical intervention, with attention to key components of the clinical interview and exam, optimal diagnostic evaluation, indications for and the goals of operative intervention, perioperative considerations, and strategies for complication mitigation. This is not a surgical atlas, but rather, a road map for the journey to the operating room door. The intent is to establish a systematic, evidence-based action plan for the patient presenting in neurologic crisis.Each chapter opens with a relevant case vignette and then unfolds through uniform sections to tell the story of how one might approach the disease entity in question, from initial request for consultation to definitive management, highlighting steps of the decision-making process. Each chapter is punctuated by 3-5 teaching pearls, summarizing these key elements. The overall goal is to create a framework for assessment that might be applied in the emergency department, the trauma bay, or the ICU when a neurologic emergency arises.The scope encompasses not only cranial and spinal trauma, but also entities such as shunt failure, stroke, aneurysmal subarachnoid hemorrhage, pituitary apoplexy, cauda equina syndrome, and central nervous system infection that might require time-sensitive intervention. An additional section addresses issues requiring emergent neurosurgical response in the ICU setting, including sudden neurologic worsening, status epilepticus, and abnormal clotting/ coagulopathy.
In the Trauma Bay
Acute Extra-Axial Hematoma
Chronic Subdural Hematoma
Contusion and Diffuse Injury
Penetrating Brain Injury
Concussion
Traumatic Arterial and Venous Injuries
Cerebrospinal Fluid Fistulae
Decompressive Craniectomy
Cervical Spine Fractures/​Acute Cervical Spinal Cord Injury
Thoracolumbar Spine Fractures
Central Cord Syndrome
Peripheral Nerve Injury
In the Emergency Department
Ischemic Stroke
Spontaneous Intracerebral Hemorrhage (Including Posterior Fossa)
Aneurysmal Subarachnoid Hemorrhage
Pituitary Apoplexy
Hydrocephalus and Shunt Failure
Acute Intracranial Infection
Nontraumatic Spinal Cord Compression
Cauda Equina Syndrome
In the ICU
Sudden Neurologic Worsening in the Postoperative Patient
Fever in the Neurocritically Ill Patient
Seizure and Status Epilepticus
Encephalopathy and Delirium
Thrombosis and Coagulopathy