Delayed Medical Response Leads to Coma Following Cerebral Aneurysm Coiling

Case Overview

This case study involves an adult patient who underwent a cerebral aneurysm coiling procedure. After the operation, the individual was admitted to the Intensive Care Unit (ICU) with an External Ventricular Drain (EVD) placed for Intracranial Pressure (ICP) monitoring. On the second postoperative day, due to malfunctioning of the EVD, it was decided to replace it with a lumbar drain. However, during this process, the attending physician was called away for an emergency and did not return for at least an hour.

Following the successful placement of the lumbar drain, no ICP measurements were taken despite the patient's escalating headache. Several hours passed without any response from a physician even after being alerted about the patient's severe pain, which led to the patient performing alligator rolls as per chart documentation. Eventually, the patient rapidly deteriorated and fell into a coma. Around this time, a positive result for a microbe was found in a Cerebrospinal Fluid (CSF) culture, although it remains unclear who conducted this test and when.

The patient was stabilized but remained comatose until their transfer to a rehabilitation facility. There is some documentation indicating that she responded to light and stimuli at this facility; however, this information was never communicated to their family. Approximately one week after their transfer to rehab, the patient passed away.

Questions to the Neurology expert and their responses

How often do you care for patients in the ICU after coiling of a cerebral aneurysm?

As a board-certified neurologist and neurocritical care physician at an academic medical center, I oversee approximately 100 patients annually who undergo cerebral aneurysm coiling or clipping procedures in the neuro-ICU.

Generally, when a patient is having increasing headache pain after removal of a device such as an EVD, what should physicians do?

When a patient experiences escalating headache pain following the removal of a device like an EVD, physicians should conduct a comprehensive evaluation. This includes taking a detailed history, performing a physical examination, and considering radiographic assessment.

In general, what aspects of a patient's chart would be important in determining the cause of a patient's rapid decompensation in the ICU some time after removal of a device like an EVD and placement of a lumbar drain?

To determine the cause of a patient's rapid deterioration in the ICU post-device removal and lumbar drain placement, several elements from their chart are crucial. These include their medical history, physical exam findings, radiographic results, and laboratory findings.

About the expert

This expert is a highly accomplished neurologist and neurocritical care specialist with an extensive academic background from prestigious institutions. They are board-certified in both neurology and neurocritical care, and have contributed significantly to their field through over 100 peer-reviewed journal articles, active NIH-funded research on strokes, and serving as a reviewer for premier medical journals. Currently, they hold positions as an assistant professor of neurology at an Ivy League university and as an attending neurologist at multiple Ivy League-affiliated hospitals.

E-197731

Specialties:

Neurology