
Burr Hole
Rapid Review
- Background
- Also known as “trepanning”. Involves drilling or scraping a hole into the skull to provide drainage for expanding intracranial hematoma
- Indications
- Epidural or subdural hematoma w/ midline shift on imaging.
- Contraindications
- Lack of imaging, reasonable access to neurosurgery, GCS > 8
- Complications
- Damage to brain parenchyma, infection, bleeding.
Pearls

HINTS Exam
Rapid Review
- Background
- Physical exam technique utilized as a screening tool to distinguish central causes of vertigo (ex. Posterior stroke) from peripheral causes (ex. Vestibular neuritis)
- Indications
- Patients with acute onset, continuous vertigo.
- Contraindications
- Chronic or episodic vertigo, C-spine injury
- Complications
- Cervical injury from head impulse test.
Pearls

Lumbar Puncture
Rapid Review
- Background
- Insertion of a needle into the lumbar subarachnoid space for the purposes of measuring CSF pressure, administering therapeutic agents, or collecting CSF for laboratory testing
- Indications
- Suspected subarachnoid hemorrhage, meningitis, or GBS. May also provide relief for pseudotumor cerebri.
- Contraindications
- Trauma or overlying skin infection at insertion site. Suspected spinal epidural abscess.
- Complications
- Post-lumbar puncture headache, spinal epidural hematoma
Pearls
Deep Dive

Ventricular Shunt Aspiration
Rapid Review
- Background
- Aspirating fluid from a ventriculoperitoneal (VP) shunt may be diagnostic (evaluate for infection or blockage), as well as therapeutic (alleviates symptoms of blocked shunt).
- Indications
- Suspected VP shunt infection, meningitis, or blockage
- Contraindications
- Infection over entry site. Relative contraindications include coagulopathy, lack of shunt imaging/information.
- Complications
- Infection (low risk), bleeding, CSF leak, ventricular collapse, or misplaced tap.
Pearls
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