Case 19 Cerebellar Tumor and VwD

Question 1

What is Von willebrand’s disease?

Answer 1

• Most common inherited coagulation disorder, caused by qualitative or quantitative defects of vWF in plasma.
• vWF plays important role in primary hemostasis and coagulation by mediating platelet adhesion to the subendothelial surface of blood vessels (via GpIB), fascilitating platelet to platelet aggregation (GPIIB3A) , and functioning as stabilizer of Factor 8
• Type 1 vWD: Most common, 80-85% of cases, represents QUANTITATIVE defect in plasma vWF levels
  
  • leads to milder symptoms of mucocutaneous bleeding, menorrhagia, GI bleed, easy bruising
• Type 2 vWD: QUALITATIVE defect leading to severe bleeding 2/2 abnormalities in hemostasis and coagulation (hemarthrosis, severe mucosal bleeding, muscle hematomas).

Question 2

What is Cerebral Perfusion Pressure?

Answer 2

CPP = MAP - ICP

Question 3

Factors that can be implememted to Reduce Intracranial Pressure

Answer 3

• Hyperventilation of patient to PaCO2 ~30
• Ensuring unobstructed venous drainage and elevation of head to 30 degrees to fascilitate drainage
• Administering mannitol (increase in osmolarity draws water from extravascular brain tissue) and or diuretic
• Administer corticosteroid, which is thought to reduce ICP by stabilizing capillary membranes around brain tumor (vasogenic cerebral edema)
• Administer cerebral vasoconstricting agen such as propofol
• Ask surgeon to perform ventriculostomy to allow drainage of CSF

Question 4

Factors to avoid that may increase intracranial pressure

Answer 4

• Hypoventilation
• Sympathetic stimulation
• Hypotension
• Hypervolemia