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Cysts These benign fluid-filled intracranial lesions typically present incidentally or with mass e ff ect or hydrocephalus. Treatment of symptomatic or enlarging lesions is usually surgical, involv - ing excision, endoscopic fenestration into a cistern or ventri...

Epilepsy Up to 10% of the population will su ff er a seizure at some point in their lives, and epilepsy , a syndrome of recurrent unpro voked seizures, represents the most common neurological disorder. About 20–30% of patients fail to achieve adequate seizur...

FUNCTIONAL NEUROSURGERY Functional neurosurgery aims to relieve epilepsy , movement disorders or pain by ablation or stimulation of brain tissue and nerves. Summary box 48.12 Paediatric neurosurgery /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25...

HYDROCEPHALUS The total volume of CSF is normally about 150 /uni00A0 mL. Produc tion from the walls of the ventricles and the choroid plexus is about 20 /uni00A0 mL/h. Hydrocephalus refers to an increase in CSF volume with ventricular enlargement, often pres...

INTRACRANIAL INFECTION Meningitis Meningitis describes inflammation of the meninges of the brain and spinal cord, most commonly and most seriously due to bacterial infection. The clinical features of meningeal irritation or meningism are fever, headache, nec...

Intracerebral haemorrhage Intracerebral haemorrhage (ICH) typically presents with sudden focal deficit and a reduced conscious level. Following initial resuscitation, these patients will require CT scan to establish the diagnosis and the size and position of t...

Introduction No content extracted automatically.

Investigation of raised intracranial pressure CT is a first-line investigation to identify causes of raised ICP , including mass lesions, bleeds, cerebral oedema and hydro cephalus, and to guide treatment. Outside the emergency setting many pathologies, as wel...

Learning objectives To understand the physiology of raised intracranial • pressure, cerebrospinal /f_l uid circulation and intracranial blood /f_l ow To recognise central nervous system infection, and • understand the acute management To be familiar with cause...

Medical management Patients should be placed on bed rest with hourly neuro - observations. They require strict input–output monitoring and intravenous fluid replacement with normal saline initially . Oral - nimodipine at a dose of 60 /uni00A0 mg every 4 hours ...

Movement disorders Prior to the development of levodopa drug therapy , surgical ablation of the subthalamic nucleus (STN) or globus pallidus interna (GPi) was a mainstay of management for Parkinson’s disease. Inhibition of the action of these centres remain...

Neural tube defects Failure of closure of the neural tube is associated with folate deficiency , family history and some anticonvulsants. Prenatal screening, using serum α -fetoprotein levels and ultrasound, and diagnostic testing, using amniocentesis, are po...

Neurosurgery in occlusive vascular disease In a subgroup of patients with completed ischaemic strokes, generally in the middle cerebral artery territory or posterior fossa, there is a role for decompressive craniectomy in the 2–3 days after ictus to manage ...

Obstructive and communicating hydrocephalus Hydrocephalus ( Figure 48.5 ) almost always reflects obstruc - he tion to circulation (an obstructive hydrocephalus; Figure 48.6 ) or failure of reabsorption (a communicating hydrocephalus; - Figure 48.7 ) ( Table 48...

PRACTICAL AND ETHICAL ISSUES Creutzfeldt–Jakob disease Creutzfeldt–Jakob disease (CJD) is a rare transmissible - spongiform encephalopathy producing a rapidly progressive dementia; it is uniformly fatal. The causative agent seems to be a misfolded protein – a ...

PRACTICAL AND ETHICAL ISSUES Creutzfeldt–Jakob disease Creutzfeldt–Jakob disease (CJD) is a rare transmissible - spongiform encephalopathy producing a rapidly progressive dementia; it is uniformly fatal. The causative agent seems to be a misfolded protein – a ...

Pain syndromes Neurosurgical approaches to the relief of pain may address the underlying aetiology directly or may seek to interrupt or modu - late the transmission responsible for the pain. The contrasting An essay on the shaking pals y in 1817. nal neuralg...

Pituitary tumours Most tumours in the sellar region are benign pituitary adeno - mas, but pathology in this region can also include malignant variants as well as craniopharyngiomas, meningiomas, aneu - - rysms and Rathke’s cleft cysts ( Figure 48.26 ). Microad...