NCCEd: Neurocritical Care Education for Residents

An 51 year-old man has been admitted to the NCCU for management of an acute left caudate IPH with intraventricular extension. He had been originally brought to the ED by EMS after having been found down. He was dysarthric and had right hemiparesis. He had required intubation in the ED for airway protection, then neurosurgery placed an urgent EVD for obstructive hydrocephalus. Their post-EVD scan is shown below. The patient greatly improved from a mentation standpoint, and was able to be extubated five days later.

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It's now day 6 of admission, and the patient is still in the NCCU. He was made floor status in the morning during rounds. However, the bedside nurse now comes over to you and tells you the patient is now having right-sided shaking movements. You go over to assess.

From the doorway, you can already see that he's having right arm rhythmic flexion/extension movements. His eyes are open, but he doesn't respond to voice or noxious stimuli. He doesn't blink to threat. His nurse says that he just started doing this three minutes ago. His EVD has been draining well and his ICPs have been normal.