Intracranial Suppuration, Brain Abscesses, Subdural Empyema, and Cranial Tuberculomas — WACS Viva & Clinical Scenarios (Neuroanaesthesia)

Exam-style intracranial suppuration, brain abscesses, subdural empyema, and cranial tuberculomas viva scenarios with examiner probes and model answers for…

Scenarios covered

• SCENARIO 1: A 17-year-old boy presents with a 2-week history of foul-smelling ear discharge, followed by severe headache, projectile vomiting, and deteriorating sensorium (GCS 10). Brain CT demonstrates a 5 cm multiloculated ring-enhancing lesion in the left temporal lobe with marked surrounding oedema and midline shift. He is pyrexic (39.5°C), tachycardic (130 bpm), and has a blood pressure of 90/50 mmHg. He is scheduled for emergency burr hole aspiration. Detail your anaesthetic stabilization, induction, and neuroprotective strategy.
• SCENARIO 2: A 22-year-old woman with severe frontal sinusitis presents with puffy swelling over her forehead (Pott's puffy tumour), left-sided hemiparesis, and continuous focal twitching of her left arm and face. CT brain reveals a massive right hemispheric subdural empyema with cortical venous thrombophlebitis. She is rushed to theatre for emergency wide decompressive craniectomy. Outline your plan to control status epilepticus, manage septic cerebral perfusion, and deliver slack brain.
• SCENARIO 3: A 35-year-old HIV-positive patient on antiretroviral therapy presents with multiple intracranial masses. MRI shows multiple thick ring-enhancing lesions in the basal ganglia with substantial perilesional vasogenic oedema. A diagnostic craniotomy and biopsy is planned. Discuss your preoperative evaluation, differential diagnoses, anaesthetic management, and infection control protocols in the operating theatre.
• SCENARIO 4: During craniotomy and capsule excision of a deep-seated frontal brain abscess, the abscess wall ruptures abruptly into the lateral ventricle, spilling thick pus into the ventricular system. The surgeon immediately initiates copious ventricular irrigation with vancomycin-saline solution. Detail the immediate physiological hazards, anaesthetic concerns, and crisis management.