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Patients who are refractory to medical management can be candidates for surgical treatment such as anatomical or functional hemispherectomy. This chapter presents a case study of a 10-month-old male with left-sided hemiparesis. The patient subsequently developed seizures refractory to medical treatment and presented for a right functional hemispherectomy. Postoperatively, antithrombin III (ATIII) levels were checked twice daily and infusions of thrombate III were dosed accordingly. Early surgery for intractable epilepsy is recommended as it has been shown to improve functional outcomes. Anatomic hemispherectomy consists of the resection of the frontal, parietal and occipital cortices, complete temporal lobectomy and insular resection. Perioperative complications associated with this procedure include significant changes in systemic and pulmonary vascular resistance, arrhythmias, cardiac arrest, neurogenic pulmonary edema, seizures, cerebral edema, massive blood loss, and coagulopathy. Patients undergoing hemispherectomy are usually on chronic anticonvulsant therapy.
The major factors in predicting neurologic dysfunction secondary to cardiac arrest involve the extent of brain insult as a function of time to return of circulation. The use of induced hypothermia has been studied as a way to combat neurologic injury for nearly five decades. This chapter presents a case study of a 37-year-old female with a history of chronic back pain and depression following a witnessed cardiac arrest 1 week after beginning risperidone therapy. The use of therapeutic hypothermia is widely accepted as the standard of care for preserving neurologic function following cardiac arrest. Cooling should be performed in all postcardiac arrest patients regardless of documented dysrhythmia, but supportive data are strongest for patients who are post ventricular fibrillation. Therapeutic hypothermia has been shown to be relatively safe and effective, and should be considered in the treatment of comatose patients following cardiac arrest.