Neurointensive Care and Perioperative Management — WACS Viva & Clinical Scenarios (Basic Neurosciences and Neurosurgical Critical Care)

Exam-style neurointensive care and perioperative management viva scenarios with examiner probes and model answers for Neurosurgery candidates.

Scenarios covered

• SCENARIO 1: A 28-year-old male is admitted to the neurosurgical intensive care unit following evacuation of an acute subdural hematoma. An external ventricular drain (EVD) is in situ with an opening pressure of 26 mmHg. Detail your systematic multimodal neuromonitoring strategy and articulate the tiered escalation protocol for refractory intracranial hypertension in this patient.
• SCENARIO 2: A 45-year-old female undergoes an uneventful transsphenoidal resection of a non-functioning pituitary macroadenoma. On postoperative day two, her urine output increases to 500 mL per hour for three consecutive hours. Formulate the differential diagnosis, diagnostic evaluation, and immediate management protocol to distinguish and treat Central Diabetes Insipidus (CDI), Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH), and Cerebral Salt Wasting (CSW).
• SCENARIO 3: A 52-year-old female who underwent surgical clipping of a ruptured anterior communicating artery aneurysm six days ago develops progressive confusion and right-sided hemiparesis. Detail the diagnostic criteria for delayed cerebral ischemia (DCI), the bedside and non-invasive monitoring modalities used to detect cerebral vasospasm, and the pharmacologic and endovascular therapeutic protocols.
• SCENARIO 4: Outline the clinical prerequisites, bedside neurological examination steps, and the formal apnea testing procedure required to confirm brainstem death in a patient with a catastrophic intracranial hemorrhage, including the indications and options for ancillary confirmatory testing.
• SCENARIO 5: A 34-year-old male with severe traumatic brain injury and an initial Glasgow Coma Scale (GCS) score of 6 arrives in the emergency department with acute respiratory compromise and suspected raised intracranial pressure. Describe your protocol for rapid sequence intubation (RSI), mechanical ventilation targets, and blood pressure goals designed to minimize secondary brain insult.