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Neuro missing > 10- raised ICP > Flashcards

10- raised ICP Flashcards

1
Q

what does the monro-kellie doctrine say

A

increase in volume of either CSF, blood or brain must be offset by decrease in volume

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2
Q

what is reduced first to reduce ICP

A

CSF and venous blood

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3
Q

describe change in ICP and volume over time

A
  • initially compensatory changes can buffer

- as they deplete then ICP rises rapidly

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4
Q

what can cause too much CSF (cause of raised ICP)

A

congenital
-hydrocephalus

acquired
-bleed/tumour obstructing drainage

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5
Q

what can cause too much blood (cause of raised ICP)

A

outside cerebral vessels

  • intrcranial haemorrage
  • haemorrhagic stroke

inside cranial vessels

  • increased arterial pressure (malignant hypertension)
  • increased venous pressure (SVC obstruction)
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6
Q

what can cause too much brain (cause of raised ICP)

A

cerebral oedema secondary to trauma, infection, ischemia and infarct

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7
Q

what is hydrocephalus

A

a buildup of CSF in ventricles

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8
Q

how to treat hydrocephalus

A

short term- extra ventricular device to drain CSF from lateral ventricle

long term- shunts from ventricular system to peritoneum or to right atrium

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9
Q

what can caused raised ICP

A
  • tumour
  • cerebral abscess
  • idopathic intracranial hypertension
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10
Q

which cause of raised ICP can be treated with lumbar puncture

A

idiopathic intracranial hypertension

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11
Q

2 major consequences of raised intracranial pressure

A
  • brain ischemia due to impaired cerebral perfusion

- compression and herniation of the brain

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12
Q

what determines cerebral blood flow

A

cerebral perfusion pressure

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13
Q

how to calculate cerebral perfusion pressure CPP

A

CPP= mean arterial pressure - ICP

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14
Q

role of cerebral autoregulation

A

keeps CPP and cerebral blood flow the same despite variations in MAP

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15
Q

what range can the brain autoregulate between

A
  • can stabilise CPP and therefore CBF between 50 and 150 mmHg.
  • below this it cannot dilate arterioles anymore (50mmHg is max vasodilation)
  • above 150 it cannot vasoconstriction arterioles anymore (150mmHg is max vasoconstriction)
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16
Q

what happens if the brain cannot auto regulate and when does this occur

A

occurs when

  • the brain tissue is damaged
  • lower than 50 or higher than 150

without autoregulation the CPP and CBF is dependent and respnsive to changes in MAP

17
Q

what is the response of the brain to increased ICP

A
  • vasodilation of cerebral arterioles (autoregulation) increases cerebral blood flow to maintain CPP
  • elevate MAP by increasing systemic BP
18
Q

describe the effects of an expanding mass on ICP

A
  • compensation by extrusion of CSF and venous blood
  • rising ICP reduces CPP and so reduces CBF. so autoregulation causes cerebral vasodilation and increased MAP to oppose reduction in CPP
  • ICP rises but brain cannot compensate further
  • hypoxic brain
  • compression on brain and brainstem
19
Q

symptoms raised ICP

A
  • reduced visual acuity
  • papilloedema
  • diplopia
  • headache worsening in mornings and when leaning forwards
  • vomiting
  • seizures
  • reduced GCS (confusion/drowsiness)
  • Increased BP
  • focal neurological signs
  • difficulty concentrating
20
Q

radiological features of raised ICP

A

midline shift (subfalcrine herniation), effacement of ventricles, loss of grey white matter differentiation

21
Q

describe subfalcine herniation

A

cingulate guys under faux cerebri. causes compression pf anterior cerebral artery

22
Q

describe transtentorial hernitation

A

uncal herniation

-causes CNIII lesion and compression on cerebellar peduncle causing motor signs

23
Q

describe tonsillar herniation

A

cerebellar tonsils herniate through foramen magnum, compressing brainstem. terminal in final stages

24
Q

late features of raised ICP

A
  • brain herniation

- cushings triad- raised BP, bradycardia, irregular breathing (compression on cardio resp centres in medulla)

25
Q

how to treat raised ICP

A
  • resuscitate
  • elevate head of bed to maximise cerebral venous return
  • adequate oxygenation and avoid hypo/hyperventilation to max brain blood flow and prevent cerebral vasoconstriction
  • maintain normal blood pressure to avoid hypotension.
  • decrease cerebral metabolic rate
26
Q

ongoing management of raised ICP

A
  • osmotherapies such as hypertonic saline or mannitol

- bolt or external ventricular drain to continuous monitor pressure

Neuro missing (19 decks)

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