Intracranial lesioning

Oral/Suppositories - Use on as-needed basis respiratory depression acute or severe bronchial asthma paralytic ileus obstetrical analgesia (8 mg tablets, oral solution, and suppositories only) intracranial lesion associated with increased intracranial pressure (2 and 4 mg tablets only). 

Head injury and increased intracranial pressure The possible respiratory depressant effects and the potential of potent analgesics to elevate cerebrospinal fluid pressure may be markedly exaggerated in the presence of head injury, intracranial lesions, or a preexisting increase in intracranial pressure. 

Head injury/increased intracranial presswre.Buprenorphine may elevate cerebrospinal fluid (CSF) pressure use with caution in head injury, intracranial lesions, and other states where CSF pressure may be increased. Buprenorphine can produce miosis and changes in consciousness levels that may interfere with patient evaluation. 

Lubiprostone (Amitiza) [Laxative] Uses Chronic idiopathic constipation in adults Action Selective Cl channel activator Dose Adults. 24 meg PO bid w/ food Contra Mechanical GI obst Caution [C, /-] Severe D, severe renal or mod-severe hepatic impair Disp Gel, caps meg SE N, HA, D, GI distention, abd pain EMS Monitor for signs of electrolyte disturbances and h5rpovolemia d/t D OD May cause severe D, hypovolemia, and abd pain/cramps give IV fluids Lutropin Alfa (Luveris) [Hormone] Uses Inf ility Action Recombinant LH Dose 75 Units SQ w/ 75—150 Units FSH, 2 s arate inj max 14 d Caution [X, /M] Contra Primary ovarian failure, uncontrolled thyroid/adrenal dysfxn, intracranial lesion, AUB, hormone-dqjendent GU tumor, ovarian cyst, PRG Disp Inj SE HA, N, ovarian h5rpCTstimulation synd, breast pain, ovarian cysts T risk of multiple births EMS None OD Unlikely to cause life-threatening Sxs... 

At the present time, pheochromocytoma and intracranial lesions are the only causes of human hypertension which are definitely known to involve overactivity of the sympatho-adrenal system. However, presumptive evidence is accumulating to indicate that neurogenic factors may be involved in early essential hypertension, and it is possible that adequate adrenergic blockade early in the course of such hypertension may be effective in aborting its development. Only additional evidence regarding the etiology of essential... 

Groch SN, Hurwitz LJ, Wright IS, McDowell F (1960) Intracranial lesions simulating cerebral thrombosis. JAMA 172 1469-1472... 

Patients with preexisting tumors or growth hormone deficiency secondary to an intracranial lesion should be examined routinely for progression or recurrence of the underlying disease process. In pediatric patients, clinical literature has revealed no relationship between somatropin replacement therapy and central nervous system (CNS) turmor recurrence or new extrracranial tumors. However, in childhood cancer survivors, an increased risk of a second neoplasm has been reported in patients treated with somatropin after their first neoplasm. Intracranial tumors, in particular meningiomas, in patients treated with radiation to the head for their first neoplasm, were the most common of these second neoplasms. In adults, it is unknown whether there is any relationship between somatropin replacement therapy and CNS tumor recurrence... 

Omnitrope should not be used when there is any evidence of neoplastic activity. Intracranial lesions must be inactive and antitumor therapy complete prior to the institution of therapy Omnitrope should be discontinued if there is evidence of tumor growth... 

Structural intracranial lesions tumor, chronic subdural hematoma, vascular malformation, giant aneurysm Multiple sclerosis... 

Gradual onset of stroke over hours or days, rather than seconds or minutes, is unusual and is much more likely to occur in ischemic than in hemorrhagic stroke. If the onset is gradual, and not Ukely to be caused by low flow or migraine (Ch. 8), then a structural intracranial lesion must be excluded. In younger patients, multiple sclerosis should also be considered. However, focal neurological deficits that develop over hours, or up to two days, in elderly patients are still most likely to have a vascular cause since vascular disease is so common in older patients. 

Giant cell arteritis (or other inflammatory vascular disorders) (Ch. 6) Structural intracranial lesion (Chs. 8 and 9) intracranial venous thrombosis (Ch. 29)... 

Blood tests should be ordered to rule out syphilis in cases of a tonic pupil. If there is associated pain, the patient should receive a workup for an intracranial lesion or orbital mass. 

Pseudotumor cerebri (PTC) is a syndrome characterized by papilledema consequent to increased ICP that is not due to a space-occupying intracranial lesion or other cause. PTC, a diagnosis of exclusion, is seen most frequently in young to middle-aged (10- to 50-year-old) obese women, with a peak incidence in the third decade. 

The majority of patients infected with the human immunodeficiency virus (HIV) have abnormalities in the central nervous system. It is frequently possible to provide a specific diagnosis on the basis of abnormalities seen by MR imaging the diagnosis is difficult in the presence of focal abnormalities with mass effect, as for example the differentiation between toxoplasmosis and cerebral lymphomas. Some clinicians recommend that all patients with AIDS and brain masses should first receive antibiotics for toxoplasmosis [83]. If improvement does not occur after medication, biopsy is considered. The most accurate diagnosis could be achieved by brain biopsy, but this can lead to substantial morbidity and mortality. Any technique that allows earlier diagnosis would enable earlier commencement of appropriate therapy. This is of particular importance in the case of lymphoma because untreated mean survival is short whereas radiation therapy and steroids may improve survival. H MRS showed significantly different biochemical profiles for AIDS-related brain lesions in 26 patients, which helped in correct diagnosis [83]. HIVpositive patients (109) were found to have focal intracranial lesions [84] 56 of these... 

Figure 14.48 Signal enhancement of intracranial lesion upon administration of 0.1 mmol/kg of a Gd + agent (a) precontrast image and (b) postcontrast image. Note the increase in intensity of the mass to the left in (b). (Reprinted from Rajan, S. S. 1998. MRI. A Conceptual Overview, 71, Figure 5.4. New York Springer. With kind permission of Springer Science and Business Media.)...

When systemic or topical pharmacotherapy and other non-invasive approaches provide inadequate relief in patients with NP, interventional approaches may be used, including sympathetic blockade with local anesthetics, intraspinal drug delivery, spinal cord stimulation, peripheral subcutaneous nerve stimulation, or stimulation of specific central nervous system structures, and various neuroablative procedures (e.g. dorsal rhizotomy, neurolytic nerve block, intracranial lesioning). Neuroablative procedures are not reversible and should be reserved for carefully and properly selected patients with intractable pain. 

Intracranial lesions associated with increased intracranial pressure... 

This medication is absolutely contraindicated in patients who have a hypersensitivity or allergy to hydromorphone or other opioids. Hydromorphone is relatively contraindicated in those with acute or severe asthma or COED, conditions in which there is decreased ventilatory function, intracranial lesions or conditions associated with increased ICP, known or suspected paralytic ileus, or conditions resulting in respiratory depression or impairment. Patients with severe renal and/or hepatic impairment should be closely monitored for signs of respiratory depression as severe organ dysfunction may lead to poor drug metabolism and increase drug levels [3]. 

Relative caution should be used in patients with convulsive disorders, head injury, shock, a reduced level of consciousness, intracranial lesions or increased intracranial pressure, or in patients with severe hepatic impairment. 

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