Case-Based Modules > Case 3 > Stage 3

Very close! If you were to offer an acute intervention now, even if palliative, it would absolutely be a bedside EVD. You could consider placing a bolt and intraparenchymal ICP monitor first. However, you already suspect plateau waves as the etiology, which warrants rapid intervention with CSF diversion; an intraparenchymal monitor would only be diagnostic and not therapeutic.

(You might also wonder what's the harm in placing an ICP monitor first, as it could show normal ICPs. First, you'd end up wasting time as that would delay the treatment you'd need in the first place-- an EVD-- given the clinical scenario. However, if the patient has abnormal compliance-- likely the case here due to her leptomeningeal disease-- an ICP that we'd consider "normal" for most people might still actually be high for her. Thus, we need to be careful by avoiding falsely reassuring information from an ICP monitor when drainage is needed. At minimum, you could drain some CSF off as a diagnostic trial itself.)

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