1. Increased ICP

Question 1

Normal ICP

Abnor. ICP

Answer 1

< 10 mmHg - N
> 20 mmHg - moderate elevation
> 40 mmHg - severe increase

Question 2

Components of IC compartment

Answer 2

Brain, blood vessels and CSF

Question 3

Causes of increased ICP

Answer 3

• Head trauma, intracranial masses (brain tumors, sub-/epidural hematoma, abscess), or other causes of cerebral edema
• Ischemic-anoxia states (acute liver fail., hypertensive encephalopathy)
• HF, venous sinus thrombosis
• Increased CSF prod.
• Obstruction of CSF flow &/or absorption
• Idiopathic (pseudotumor cerebri)

Question 4

Consequences of increased ICP

Answer 4

Reduce CPP (cerebral perfusion pressure)
Brain compression --> ischemia, herniation, necrosis

Question 5

Treatment of increased ICP

Answer 5

• Raise the head 30 degrees from the bed (better venous drainage)
• Hyperventilation w/PCO2 btwn 25-30 mmHg (vasocon.)
• Osmotic diuretics: Mannitol
• Hypertonic saline
• Hypothermia: Cooling to 34°C lowers
• IV barbiturates: Pentobarbital (reduce cerebral metabolism)
• CSF drain. w/ventricular drain
• Hemicraniectomy
• Depends on the cause:
  o Brain tumor: Corticosteroids, resection
  o Drainage of hematoma
  o Idiopathic: Acetazolamide, nerve decompression, shunt

Question 6

Signs & symptoms

Answer 6

Headache, vomiting w/o nausea, altered consciousness, back pain, papilledema, Cushing’s triad (increased systolic BP, widened pulse P, bradycardia & abnor. resp. patterns)

Question 7

Diagnosis

Answer 7

Clinical evaluation, CT/MRI