Elevated intracranial pressure - Revision history

Danbot: Add MedicationDose SMW entries for mannitol and hypertonic saline; doses verified against neurocritical care guidelines

2026-03-20T17:42:41Z

Add MedicationDose SMW entries for mannitol and hypertonic saline; doses verified against neurocritical care guidelines

← Older revision		Revision as of 17:42, 20 March 2026
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	*Paralytics		*Paralytics
	**Risk of ICU myopathy/neuropathy with long term use.		**Risk of ICU myopathy/neuropathy with long term use.


			==Medication Dosing==
			*{{MedicationDose\|drug=Mannitol\|dose=1-1.5 g/kg\|route=IV bolus\|context=Osmotic diuretic for ICP reduction\|indication=Elevated intracranial pressure\|population=Adult\|notes=20% solution; no central line needed}}
			*{{MedicationDose\|drug=Hypertonic saline\|dose=30 mL of 23% over 15 min (or 3% NaCl at 1 mL/kg/hr)\|route=IV\|context=Hyperosmolar therapy for ICP reduction\|indication=Elevated intracranial pressure\|population=Adult\|notes=23% requires central line; target Na >145}}

	==See Also==		==See Also==

ClaireLewis at 02:19, 3 October 2019

2019-10-03T02:19:55Z

← Older revision		Revision as of 02:19, 3 October 2019
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	==Clinical Features==		==Clinical Features==
	*Headache (from increased pressure on heavily innervated meninges)		*[[Headache]] (from increased pressure on heavily innervated meninges)
	**Characteristically worse in the morning		**Characteristically worse in the morning
	*Nausea/vomiting		*[[Nausea/vomiting]]
	**Vomiting due to increased ICP typically occurs in the morning		**Vomiting due to increased ICP typically occurs in the morning, often effortless
	*Seizure		*[[Seizure]]
	*Lethargy		*[[Lethargy]]
	*CN palsies		*[[Cranial nerve palsies]]
	**CN 6 palsy (false localizing sign)		**[[abducens nerve palsy\|CN 6 palsy]] (false localizing sign)
	*~~Papilloedema~~ (bilaterally blurred optic disc margins)		*[[Papilledema]] (bilaterally blurred optic disc margins)
	*[[ECG]] with [[QT prolongation]] and T-wave inversions		*[[ECG]] with [[QT prolongation]] and T-wave inversions
	*Dilated ~~Optic~~ nerve		*Dilated optic nerve on [[ocular ultrasound]]
	**Measure optic nerve 3mm posterior to the globe, from inner wall to inner wall		**Measure optic nerve 3mm posterior to the globe, from inner wall to inner wall
	**Normal is <5mm<ref>Blaivas M, Theodoro D, Sierzenski PR. Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath. Acad Emerg Med. 2003 Apr;10(4):376-81.</ref>		**Normal is <5mm<ref>Blaivas M, Theodoro D, Sierzenski PR. Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath. Acad Emerg Med. 2003 Apr;10(4):376-81.</ref>
Line 31:		Line 31:
	''Increased ICP is due to an increase in any one of the 3 components of the intracranial space''		''Increased ICP is due to an increase in any one of the 3 components of the intracranial space''
	#Increased brain tissue		#Increased brain tissue
	#*Neoplasms		#*[[brain tumor\|Neoplasms]]
	#*Cerebral abscess		#*[[brain abscess\|Cerebral abscess]]
	#Increased CSF volume		#Increased CSF volume
	#*Decreased reabsorption		#*Decreased reabsorption
	#**Obstructive hydrocephalus		#**Obstructive [[hydrocephalus]]
	#**Non-obstructive/communicating hydrocephalus		#**Non-obstructive/communicating hydrocephalus
	#**[[Ventriculoperitoneal shunt problems\|Ventriculoperitoneal shunt problem]]		#**[[Ventriculoperitoneal shunt problems\|Ventriculoperitoneal shunt problem]]
	#Increased blood volume		#Increased blood volume
	#*Intracranial haemorrhage		#*[[ICH\|Intracranial haemorrhage]]
	#*Cerebral venous sinus thrombosis		#*Cerebral [[venous sinus thrombosis]]
	#*Failed cerebral autoregulation (causing increases CBF or CBV)		#*Failed cerebral autoregulation (causing increases CBF or CBV)

Line 65:		Line 65:
	====1st (conservative)====		====1st (conservative)====
	*Elevate Head of bed to 30-45 deg to increase CSF outflow and keep head midline		*Elevate Head of bed to 30-45 deg to increase CSF outflow and keep head midline
	**May "sandbag" head of those in c-collar to promote venous drainage(c-collar can restrict venous ~~outlfow~~)		**May "sandbag" head of those in c-collar to promote venous drainage(c-collar can restrict venous outflow)
	*Control agitation/pain		*Control agitation/pain
	**[[Opioids]], [[benzodiazepines]], sedative hypnotics		**[[Opioids]], [[benzodiazepines]], sedative hypnotics
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	*Hyperventilate to pCO2 30-35mmHg		*Hyperventilate to pCO2 30-35mmHg
	*Oxygen saturation >95%		*Oxygen saturation >95%
	**This is short term as patient will equilibrate; is only meant as a temporizing measure. Attempt to wean to normocapnia as soon as able. Further do not ~~overventilate~~ past 25mmHg as may exacerbate damage via ~~cerbral~~ hypoxia (CO2 is primarily involved in autoregulation of cerebral vasculature).		**This is short term as patient will equilibrate; is only meant as a temporizing measure. Attempt to wean to normocapnia as soon as able. Further do not over-ventilate past 25mmHg as may exacerbate damage via cerebral hypoxia (CO2 is primarily involved in autoregulation of cerebral vasculature).
	*Hypertonic fluids		*Hypertonic fluids
	**[[Mannitol]] 20% 1-1.5g/kg rapid IV bolus (no need for central line) as an osmotic diuretic to lower ICP '''OR'''		**[[Mannitol]] 20% 1-1.5g/kg rapid IV bolus (no need for central line) as an osmotic diuretic to lower ICP '''OR'''
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	====3rd (Intervention- long term)====		====3rd (Intervention- long term)====
	*Hypertonic fluid maintenance		*Hypertonic fluid maintenance
	**Iatrogenic hypernatremia. Use 3% NaCl to maintain na >145 with q6hr serum Na cks.		**Iatrogenic hypernatremia. Use [[hypertonic saline\|3% NaCl]] to maintain na >145 with q6hr serum Na cks.
	***3%NS at 1mL/kg/hr appropriate (typically start at 50mL/hr).		***3%NS at 1mL/kg/hr appropriate (typically start at 50mL/hr).
	***May continue to push Na > 145, then >150 then >155 prn to manage ICP		***May continue to push Na > 145, then >150 then >155 prn to manage ICP
	****Eventually osmotic pressures will equilibrate over days. requiring higher Na values (rationale behind pushing Na slowly upward as needed rather than pushing hypernatremia to maximum).		****Eventually osmotic pressures will equilibrate over days. requiring higher Na values (rationale behind pushing Na slowly upward as needed rather than pushing hypernatremia to maximum).
	**Iatrogenic hyperosmolar maintenance		**Iatrogenic hyperosmolar maintenance
	***[[Mannitol]] 20% 0.5g/kg q4hrs with ~~seurm~~ Osm checks q6hrs. (Target osm of 300-320 mOsm/L)		***[[Mannitol]] 20% 0.5g/kg q4hrs with serum Osm checks q6hrs. (Target osm of 300-320 mOsm/L)

	====4th (Intervention - Refractory elevation)====		====4th (Intervention - Refractory elevation)====
	*Pentobarbital coma		*[[Pentobarbital]] coma
	**loading dose: 5-20mg/kg bolus then 4mg;kg/hr titrated to burst supression on EEG.		**loading dose: 5-20mg/kg bolus then 4mg;kg/hr titrated to burst supression on EEG.
	*Induced hypothermia (32-34°F)		*Induced [[hypothermia]] (32-34°F)
	**Cooling System (ie. Arctic Sunt, Stryker Medi-Therm)		**Cooling System (ie. Arctic Sunt, Stryker Medi-Therm)
	***Must perform surveillance cultures (routine blood culture, UA, CXR) every 48 hours since artificially supressing fever.		***Must perform surveillance cultures (routine blood culture, UA, CXR) every 48 hours since artificially supressing fever.
	**Shivering protocol		**Shivering protocol
	***Vecuronium or ~~Pancuronium~~ <ref>Angela Logan et al Optimal Management of Shivering During Therapeutic [[Hypothermia]]After Cardiac Arrest Crit Care Nurse 2011;31:e18-e30 http://ccn.aacnjournals.org/content/31/6/e18.full.pdf</ref>		***[[Vecuronium]] or pancuronium <ref>Angela Logan et al Optimal Management of Shivering During Therapeutic [[Hypothermia]]After Cardiac Arrest Crit Care Nurse 2011;31:e18-e30 http://ccn.aacnjournals.org/content/31/6/e18.full.pdf</ref>
	*Paralytics		*Paralytics
	**Risk of ICU myopathy/neuropathy with long term use.		**Risk of ICU myopathy/neuropathy with long term use.
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	[[Category:Neurology]]		[[Category:Neurology]]
			[[Category:Critical Care]]

Rossdonaldson1: /* Differential Diagnosis */

2017-11-21T23:24:02Z

Differential Diagnosis

← Older revision		Revision as of 23:24, 21 November 2017
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	==Differential Diagnosis==		==Differential Diagnosis==
	{{Intracranial mass DDX}}		{{Intracranial mass DDX}}
	~~{{Headache DDX}}~~

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Differential Diagnosis */

2017-11-21T23:23:52Z

Differential Diagnosis

← Older revision		Revision as of 23:23, 21 November 2017
Line 26:		Line 26:

	==Differential Diagnosis==		==Differential Diagnosis==
			{{Intracranial mass DDX}}
	{{Headache DDX}}		{{Headache DDX}}

Mholtz: Text replacement - "-->" to "→"

2017-11-17T20:52:12Z

Text replacement - "-->" to "→"

← Older revision		Revision as of 20:52, 17 November 2017
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	***Blood (10% or 150mL)		***Blood (10% or 150mL)
	***CSF (10% or 150 mL)		***CSF (10% or 150 mL)
	**Increase in one of the components ~~-->~~ reduction of other two ~~-->must~~ maintain a fixed total intracranial volume.		**Increase in one of the components → reduction of other two →must maintain a fixed total intracranial volume.
	*CSF is created at a rate of 20mL/hr or 500mL/day.		*CSF is created at a rate of 20mL/hr or 500mL/day.
	*Neuronal injury occurs secondary to vascular compromise to brain cells either by a reduction in cerebral blood flow or direct ischemia. This is an ''' emergency''' and requires emergent intervention if sustained > 5-10 minutes		*Neuronal injury occurs secondary to vascular compromise to brain cells either by a reduction in cerebral blood flow or direct ischemia. This is an ''' emergency''' and requires emergent intervention if sustained > 5-10 minutes

Rossdonaldson1: Undo revision 148006 by Rossdonaldson1 (talk)

2017-07-21T04:13:31Z

Undo revision 148006 by Rossdonaldson1 (talk)

← Older revision		Revision as of 04:13, 21 July 2017
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	==Background==		==Background==
	*Monroe-Kellie hypothesis~~: The total volume~~ of ~~the~~ intracranial space is constant~~, and comprises~~ 3 ~~main complements, namely the brain tissue~~ (80%)~~, blood~~ (10% or 150mL) ~~and~~ CSF (10% or ~~150mL~~)~~. An increase~~ in ~~the volume of any~~ one of the components ~~must necessarily be accompanied by a~~ reduction ~~in that~~ of ~~the~~ other two ~~in order to~~ maintain ~~the~~ fixed total intracranial volume.		*Monroe-Kellie hypothesis
			**Volume of intracranial space is constant
			**3 components
			***Brain Tissue (80%)
			***Blood (10% or 150mL)
			***CSF (10% or 150 mL)
			**Increase in one of the components --> reduction of other two -->must maintain a fixed total intracranial volume.
	*CSF is created at a rate of 20mL/hr or 500mL/day.		*CSF is created at a rate of 20mL/hr or 500mL/day.
	*Neuronal injury occurs secondary to vascular compromise to brain cells either by a reduction in cerebral blood flow or direct ischemia. This is an ''' emergency''' and requires emergent intervention if sustained > 5-10 minutes		*Neuronal injury occurs secondary to vascular compromise to brain cells either by a reduction in cerebral blood flow or direct ischemia. This is an ''' emergency''' and requires emergent intervention if sustained > 5-10 minutes
Line 6:		Line 12:
	==Clinical Features==		==Clinical Features==
	*Headache (from increased pressure on heavily innervated meninges)		*Headache (from increased pressure on heavily innervated meninges)
	*Characteristically worse in the morning		**Characteristically worse in the morning
	*Nausea/vomiting		*Nausea/vomiting
	**Vomiting due to increased ICP typically occurs in the morning		**Vomiting due to increased ICP typically occurs in the morning
			*Seizure
			*Lethargy
	*CN palsies		*CN palsies
	**CN 6 palsy (false localizing sign)		**CN 6 palsy (false localizing sign)
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	===Take Stepwise approach to treatment===		===Take Stepwise approach to treatment===
	====1st (conservative)====		====1st (conservative)====
	*Elevate Head of bed to 30-45 deg and keep head midline		*Elevate Head of bed to 30-45 deg to increase CSF outflow and keep head midline
	**May "sandbag" head of those in c-collar to promote venous drainage(c-collar can restrict venous outlfow)		**May "sandbag" head of those in c-collar to promote venous drainage(c-collar can restrict venous outlfow)
	*Control agitation/pain		*Control agitation/pain
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	====2nd (Intervention-short term)====		====2nd (Intervention-short term)====
	*Hyperventilate to pCO2 30-35mmHg		*Hyperventilate to pCO2 30-35mmHg
			*Oxygen saturation >95%
	**This is short term as patient will equilibrate; is only meant as a temporizing measure. Attempt to wean to normocapnia as soon as able. Further do not overventilate past 25mmHg as may exacerbate damage via cerbral hypoxia (CO2 is primarily involved in autoregulation of cerebral vasculature).		**This is short term as patient will equilibrate; is only meant as a temporizing measure. Attempt to wean to normocapnia as soon as able. Further do not overventilate past 25mmHg as may exacerbate damage via cerbral hypoxia (CO2 is primarily involved in autoregulation of cerebral vasculature).
	*Hypertonic fluids		*Hypertonic fluids
	**[[Mannitol]] 20% 1-1.5g/kg rapid IV bolus (no need for central line) '''OR'''		**[[Mannitol]] 20% 1-1.5g/kg rapid IV bolus (no need for central line) as an osmotic diuretic to lower ICP '''OR'''
	**23% Na 30mL over 15 minutes (Needs central line)		**23% Na 30mL over 15 minutes (Needs central line)
	*Consult Neurosurgery (urgent) for possible evacuation or ventricular drainage		*Consult Neurosurgery (urgent) for possible evacuation or ventricular drainage

Rossdonaldson1: Reverted edits by Panosiaa (talk) to last revision by Mholtz

2017-07-21T04:12:53Z

Reverted edits by Panosiaa (talk) to last revision by Mholtz

← Older revision		Revision as of 04:12, 21 July 2017
Line 1:		Line 1:
	==Background==		==Background==
	*Monroe-Kellie hypothesis		*Monroe-Kellie hypothesis: The total volume of the intracranial space is constant, and comprises 3 main complements, namely the brain tissue (80%), blood (10% or 150mL) and CSF (10% or 150mL). An increase in the volume of any one of the components must necessarily be accompanied by a reduction in that of the other two in order to maintain the fixed total intracranial volume.
	**Volume of intracranial space is constant
	**3 ~~components~~
	***Brain Tissue (80%)
	***Blood (10% or 150mL)
	~~***~~CSF (10% or ~~150 mL~~)
	**Increase in one of the components ~~-->~~ reduction of other two ~~-->must~~ maintain a fixed total intracranial volume.
	*CSF is created at a rate of 20mL/hr or 500mL/day.		*CSF is created at a rate of 20mL/hr or 500mL/day.
	*Neuronal injury occurs secondary to vascular compromise to brain cells either by a reduction in cerebral blood flow or direct ischemia. This is an ''' emergency''' and requires emergent intervention if sustained > 5-10 minutes		*Neuronal injury occurs secondary to vascular compromise to brain cells either by a reduction in cerebral blood flow or direct ischemia. This is an ''' emergency''' and requires emergent intervention if sustained > 5-10 minutes
Line 12:		Line 6:
	==Clinical Features==		==Clinical Features==
	*Headache (from increased pressure on heavily innervated meninges)		*Headache (from increased pressure on heavily innervated meninges)
	**Characteristically worse in the morning		*Characteristically worse in the morning
	*Nausea/vomiting		*Nausea/vomiting
	**Vomiting due to increased ICP typically occurs in the morning		**Vomiting due to increased ICP typically occurs in the morning
	*Seizure
	*Lethargy
	*CN palsies		*CN palsies
	**CN 6 palsy (false localizing sign)		**CN 6 palsy (false localizing sign)
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	===Take Stepwise approach to treatment===		===Take Stepwise approach to treatment===
	====1st (conservative)====		====1st (conservative)====
	*Elevate Head of bed to 30-45 deg ~~to increase CSF outflow~~ and keep head midline		*Elevate Head of bed to 30-45 deg and keep head midline
	**May "sandbag" head of those in c-collar to promote venous drainage(c-collar can restrict venous outlfow)		**May "sandbag" head of those in c-collar to promote venous drainage(c-collar can restrict venous outlfow)
	*Control agitation/pain		*Control agitation/pain
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	====2nd (Intervention-short term)====		====2nd (Intervention-short term)====
	*Hyperventilate to pCO2 30-35mmHg		*Hyperventilate to pCO2 30-35mmHg
	*Oxygen saturation >95%
	**This is short term as patient will equilibrate; is only meant as a temporizing measure. Attempt to wean to normocapnia as soon as able. Further do not overventilate past 25mmHg as may exacerbate damage via cerbral hypoxia (CO2 is primarily involved in autoregulation of cerebral vasculature).		**This is short term as patient will equilibrate; is only meant as a temporizing measure. Attempt to wean to normocapnia as soon as able. Further do not overventilate past 25mmHg as may exacerbate damage via cerbral hypoxia (CO2 is primarily involved in autoregulation of cerebral vasculature).
	*Hypertonic fluids		*Hypertonic fluids
	**[[Mannitol]] 20% 1-1.5g/kg rapid IV bolus (no need for central line) ~~as an osmotic diuretic to lower ICP~~ '''OR'''		**[[Mannitol]] 20% 1-1.5g/kg rapid IV bolus (no need for central line) '''OR'''
	**23% Na 30mL over 15 minutes (Needs central line)		**23% Na 30mL over 15 minutes (Needs central line)
	*Consult Neurosurgery (urgent) for possible evacuation or ventricular drainage		*Consult Neurosurgery (urgent) for possible evacuation or ventricular drainage

Panosiaa at 18:08, 8 July 2017

2017-07-08T18:08:27Z

← Older revision		Revision as of 18:08, 8 July 2017
Line 1:		Line 1:
	==Background==		==Background==
	*Monroe-Kellie hypothesis~~: The total volume~~ of ~~the~~ intracranial space is constant~~, and comprises~~ 3 ~~main complements, namely the brain tissue~~ (80%)~~, blood~~ (10% or 150mL) ~~and~~ CSF (10% or ~~150mL~~)~~. An increase~~ in ~~the volume of any~~ one of the components ~~must necessarily be accompanied by a~~ reduction ~~in that~~ of ~~the~~ other two ~~in order to~~ maintain ~~the~~ fixed total intracranial volume.		*Monroe-Kellie hypothesis
			**Volume of intracranial space is constant
			**3 components
			***Brain Tissue (80%)
			***Blood (10% or 150mL)
			***CSF (10% or 150 mL)
			**Increase in one of the components --> reduction of other two -->must maintain a fixed total intracranial volume.
	*CSF is created at a rate of 20mL/hr or 500mL/day.		*CSF is created at a rate of 20mL/hr or 500mL/day.
	*Neuronal injury occurs secondary to vascular compromise to brain cells either by a reduction in cerebral blood flow or direct ischemia. This is an ''' emergency''' and requires emergent intervention if sustained > 5-10 minutes		*Neuronal injury occurs secondary to vascular compromise to brain cells either by a reduction in cerebral blood flow or direct ischemia. This is an ''' emergency''' and requires emergent intervention if sustained > 5-10 minutes
Line 6:		Line 12:
	==Clinical Features==		==Clinical Features==
	*Headache (from increased pressure on heavily innervated meninges)		*Headache (from increased pressure on heavily innervated meninges)
	*Characteristically worse in the morning		**Characteristically worse in the morning
	*Nausea/vomiting		*Nausea/vomiting
	**Vomiting due to increased ICP typically occurs in the morning		**Vomiting due to increased ICP typically occurs in the morning
			*Seizure
			*Lethargy
	*CN palsies		*CN palsies
	**CN 6 palsy (false localizing sign)		**CN 6 palsy (false localizing sign)
Line 56:		Line 64:
	===Take Stepwise approach to treatment===		===Take Stepwise approach to treatment===
	====1st (conservative)====		====1st (conservative)====
	*Elevate Head of bed to 30-45 deg and keep head midline		*Elevate Head of bed to 30-45 deg to increase CSF outflow and keep head midline
	**May "sandbag" head of those in c-collar to promote venous drainage(c-collar can restrict venous outlfow)		**May "sandbag" head of those in c-collar to promote venous drainage(c-collar can restrict venous outlfow)
	*Control agitation/pain		*Control agitation/pain
Line 72:		Line 80:
	====2nd (Intervention-short term)====		====2nd (Intervention-short term)====
	*Hyperventilate to pCO2 30-35mmHg		*Hyperventilate to pCO2 30-35mmHg
			*Oxygen saturation >95%
	**This is short term as patient will equilibrate; is only meant as a temporizing measure. Attempt to wean to normocapnia as soon as able. Further do not overventilate past 25mmHg as may exacerbate damage via cerbral hypoxia (CO2 is primarily involved in autoregulation of cerebral vasculature).		**This is short term as patient will equilibrate; is only meant as a temporizing measure. Attempt to wean to normocapnia as soon as able. Further do not overventilate past 25mmHg as may exacerbate damage via cerbral hypoxia (CO2 is primarily involved in autoregulation of cerebral vasculature).
	*Hypertonic fluids		*Hypertonic fluids
	**[[Mannitol]] 20% 1-1.5g/kg rapid IV bolus (no need for central line) '''OR'''		**[[Mannitol]] 20% 1-1.5g/kg rapid IV bolus (no need for central line) as an osmotic diuretic to lower ICP '''OR'''
	**23% Na 30mL over 15 minutes (Needs central line)		**23% Na 30mL over 15 minutes (Needs central line)
	*Consult Neurosurgery (urgent) for possible evacuation or ventricular drainage		*Consult Neurosurgery (urgent) for possible evacuation or ventricular drainage

Mholtz at 06:13, 7 July 2017

2017-07-07T06:13:01Z

← Older revision		Revision as of 06:13, 7 July 2017
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	**Treat shivering		**Treat shivering
	***Bair hugger (warms skin temperature)		***Bair hugger (warms skin temperature)
	***APAP 650 ~~q6prn~~ for temperature >38.5°F		***APAP 650 q6h PRN for temperature >38.5°F
	*Maintain euvolemia		*Maintain euvolemia
	*Maintain euglycemia		*Maintain euglycemia

Mholtz: Text replacement - "OR" to "'''OR'''"

2017-05-30T20:31:15Z

Text replacement - "OR" to "'''OR'''"

← Older revision		Revision as of 20:31, 30 May 2017
Line 74:		Line 74:
	**This is short term as patient will equilibrate; is only meant as a temporizing measure. Attempt to wean to normocapnia as soon as able. Further do not overventilate past 25mmHg as may exacerbate damage via cerbral hypoxia (CO2 is primarily involved in autoregulation of cerebral vasculature).		**This is short term as patient will equilibrate; is only meant as a temporizing measure. Attempt to wean to normocapnia as soon as able. Further do not overventilate past 25mmHg as may exacerbate damage via cerbral hypoxia (CO2 is primarily involved in autoregulation of cerebral vasculature).
	*Hypertonic fluids		*Hypertonic fluids
	**[[Mannitol]] 20% 1-1.5g/kg rapid IV bolus (no need for central line) OR		**[[Mannitol]] 20% 1-1.5g/kg rapid IV bolus (no need for central line) '''OR'''
	**23% Na 30mL over 15 minutes (Needs central line)		**23% Na 30mL over 15 minutes (Needs central line)
	*Consult Neurosurgery (urgent) for possible evacuation or ventricular drainage		*Consult Neurosurgery (urgent) for possible evacuation or ventricular drainage