Hydrocephalus and Raised ICP

Question 1

what is ICP?

Answer 1

the pressure exerted by the cranium on the brain tissue, CSF and blood volume

Question 2

ICP at rest

Answer 2

7-15 mmHg

Question 3

compensatory mechanisms to an increased ICP

Answer 3

decreasing CSF volume, blood volume and ECF

Question 4

how to calculate CPP

Answer 4

MAP - ICP (normal is 80)

Question 5

causes of raised ICP

Answer 5

mass effect
brain swelling
increased CVP
problems with CSF flow

Question 6

early signs of raised ICP

Answer 6

reduced consciouness
headache
papilloedema
changes in vision
N&V

Question 7

late signs of raised ICP

Answer 7

coma
fixed dilated pupils
hemiplegia
bradycardia (Cushing's triad)
hyperthermia
increased UO

Question 8

management of raised ICP

Answer 8

loose collars, bed tilt
diuretics e.g. mannitol, hypertonic saline
surgical decompression
acetazolamide used in chronic as slow acting
shunts

Question 9

shunts used in raised ICP

Answer 9

LP
ventriculoperitoneal
ventriculopleural

Question 10

presentation of normal pressure hydrocephalus

Answer 10

Hakim’s triad= abnormal gait, dementia and urinary incontinence
elderly

Question 11

diagnosis of normal pressure hydrocephalus

Answer 11

MRI shows large Sylvain fissures

Question 12

management of normal pressure hydrocephalus

Answer 12

shunt

Question 13

demographic of idiopathic intracranial hypertension (IIH)

Answer 13

women of child-bearing age

overweight

Question 14

management of IIH

Answer 14

weight loss (bariatric surgery)
CA inhibitors e.g. acetazolamide, topiramate
diuretics
shunt
radiology intervention