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Category: Critical Care Medicine-Neurologic Disorders--->Increased Intracranial Pressure
Page: 2

Question 6#Print Question

A 59-year-old female with no past medical history is admitted to the neurointensive care unit following a large right middle cerebral artery ischemic stroke. She was not a candidate for intravenous tPA nor intra-arterial therapy. She has had progressive somnolence and anisocoria with a right larger than left pupil that was not responsive to direct or consensual light testing. She was started on hyperosmolar therapy followed by a decompressive hemicraniectomy. She is now poststroke day 5 and continues to have malignant cerebral edema. Prior to her next dose of mannitol her lab values are as follows:

  • Na 150
  • K 3.4
  • Cl 116
  • HCO24
  • BUN 10
  • Cr 0.32
  • Glucose 187
  • Calcium 7.3
  • Osmolality 314

What is her osmolar gap?

a. 0
b. 6
c. 14
d. 53


Question 7#Print Question

A 53-year-old, right-handed, previously independent male with no past medical history was found down at home. He was brought to the emergency department where he was found to have a large, wellestablished L MCA ischemic stroke on CT with a proximal L M1 thrombus on CT angiogram. He was not a candidate for IV tPA or intra-arterial therapy given the well established infarction and his last known well-being over 12 hours prior to presentation. He was admitted to the intensive care unit for ongoing management. Over the course of the next 24 hours he has progressive decline in his mental status and required intubation. A repeat head CT shows evolution of the ischemic stroke with left-to-right midline shift.

What is the best description of the anticipated outcome following a hemicraniectomy for malignant ischemic stroke?

a. A hemicraniectomy can potentially be a life-saving intervention and will improve neurologic recovery
b. A hemicraniectomy can potentially be a life-saving intervention but will not improve neurologic recovery
c. Because the ischemic stroke is on the dominate hemisphere, hemicraniectomy should be completed as there is a higher chance of recovery
d. Hemicraniectomy without durotomy is preferred as there is a lower risk of infection as compared to hemicraniectomy with durotomy




Category: Critical Care Medicine-Neurologic Disorders--->Increased Intracranial Pressure
Page: 2 of 2