Neurologic Catastrophe in the CT ICU: A Neurosurgeon’s Dilemma

  • Emily P. Sieg
  • Russell A. Carter
  • Shelly D. TimmonsEmail author
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)


Neurosurgical emergencies in the Cardiothoracic Surgery Intensive Care Unit (CTICU) are primarily comprised of intracerebral hemorrhages occurring as a result of thromboembolic ischemic infarction with hemorrhage conversion, falls resulting in traumatic hemorrhages and spontaneous hemorrhagic complications, all of which are complicated by the antithrombotic medication (ATM) regimens required for implanted cardiac devices. Ischemic cerebral infarctions requiring decompressive craniotomy may also occur but are not a focus of this chapter, which will instead concentrate on hemorrhagic intracranial complications related to ventricular assist devices and valve surgery in the absence of bacterial endocarditis or mycotic aneurysms. Resumption of antithrombotic medications after intracranial hemorrhage (ICH) in the face of thrombogenic cardiac devices is an oft-encountered clinical dilemma for which little data exist, and will also be discussed.


Intracerebral hemorrhage Intraparenchymal hemorrhage Intraventricular hemorrhage Subarachnoid hemorrhage Subdural hematoma Left ventricular assist device Valve replacement Valve surgery Antithrombotic medications Antiplatelet medications Anticoagulant medications Anticoagulation 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Emily P. Sieg
    • 1
  • Russell A. Carter
    • 2
  • Shelly D. Timmons
    • 1
    Email author
  1. 1.Department of NeurosurgeryPenn State University Milton S. Hershey Medical CenterHersheyUSA
  2. 2.Department of Cardiothoracic SurgeryGeisinger Health SystemDanvilleUSA

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