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Extra resources for Acute Surgical Management
E. eye, verbal and motor responses (Table 1). A GCS score of 3 indicates that the patient is in deep coma, while a fully conscious and Table 1 Points Best Eye Opening 6 5 4 3 2 1 – – Spontaneous To speech To pain None *Children The Glasgow Coma Scale (GCS) Best Verbal Response* Best Motor Response – Obeys Oriented Localises pain Confused Flexion withdrawal Inappropriate words Abnormal flexion (decorticate) Incomprehensible sounds Extension (decerebrate) None None younger than two years should receive full verbal scoring if they cry after stimulation.
Bleeding occurs into the potential space between the dura and the skull. This may take time to occur, and a lucid interval may be found, before clinical deterioration occurs. Because the pathology is essentially outside the brain, the prognosis is good provided the haematoma is evacuated soon enough. Acute subdural haematomas Bleeding occurs into the subdural space, lying between the dura and the arachnoid. This can occur in two circumstances: (1) Bleeding from a torn bridging vein, especially in the elderly.
4 and 5). The definitive treatment is to re-establish or divert the CSF flow, and there are several methods of achieving this. The time-tested conventional method is to insert a Paediatric Neurosurgical Emergencies Fig. 4 47 Axial CT scan of the brain showing large lateral ventricles. Fig. 5 Axial CT scan of the brain showing a large rounded third ventricle in addition to large frontal and temporal horns of the lateral ventricles. shunt, with the safest being the ventriculo-peritoneal (VP) shunt.