Increased ICP

Question 1

causes of increased ICP

Answer 1

idiopathic

infection

inflammation

space-occupying lesions

hydrocephalus

metabolic disturbance e

levated venous pressure

Question 2

complications of increased ICP

Answer 2

decreased cerebral perfusion pressure

herniation

Cushing triad

coma

irreversible loss of brain function

apnea

cerebral edema

Question 3

Mechanism of Vasogenic Edema

Answer 3

increased ECF due to disruption of the BBB and increased vascular permeability

Question 4

Morphology findings of vasogenic edema

Answer 4

protein-rich infiltrated from a paucity of lymphatics

Question 5

Mechanism of interstitial edema

Answer 5

CSF is blocked in periventricular white matter due to hydrocephalus

Question 6

Mechanism of cytotoxic edema

Answer 6

increased ECF secondary to neuronal, glial or endothelial membrane injury

Question 7

Mechanism of Subfacine (Cingulate) Herniation

Answer 7

gyrus of one hemisphere is compressed and herniates under the falx cerebri

Question 8

complications of subfalcine herniation

Answer 8

obstruction of foramen of Monro leads to hydrocephalus

Question 9

contralateral lower limb hemiparesis

hydrocephalus

Answer 9

Subfalcine (Cingulate) Herniation

Question 10

Mechanism of Uncal Herniation

Answer 10

medial temporal lobe herniates at the free margin of the tentorium, compressing ipsilateral

CN3

PCA

cerebral peduncle

brain stem

Question 11

blown pupil with ptosis and down/ out positioning

contralateral homonymous hemianopia with macular sparing

hemiparesis

Duret hemorrhages

Answer 11

Uncal herniation

Question 12

respiratory arrest

unstable blood pressure

impaired circulation

Answer 12

tonsillar herniation

Question 13

mechanism of tonsillar herniation

Answer 13

cerebellar tonsil herniates through the foramen magnum, compressing the medulla

Question 14

what is Cushing’s triad

Answer 14

Bradycardia

HTN

Irregular breathing

Question 15

Difference between communicating and noncommunicating hydrocephalus

Answer 15

Communicating: impaired absorption/ production of CSF

Noncommunicating: obstruction of CSF passage from ventricles to SA space

Question 16

signs of Normal pressure hydrocephalus

Answer 16

wet

wacky

wobbly

Question 17

What is hydrocephalus ex vacuo

Answer 17

hydrocephalus due to decreased brain mass

Question 18

Delineate Cushing’s Triad

Answer 18

1. increased ICP leads to decreased CCP
2. Decreased CCP eads to compensatory activation of sympathetics to maintain perfusion
3. increased sympathetics increases BP
4. increased BP stimulates aortic arch baroreceptors to activate parasympathetics

Question 19

CCP equation

Answer 19

Mean arterial pressure- ICP

Question 20

What is pseudomotor cerebri

Answer 20

idiopathic mismatch between production and reabsorption of CSF, causing damage to structures of CNS and optic nerve fibers

Question 21

clinical presentation of pseudomotor cerebri

Answer 21

recurrent HA (worse with lying down)

transient vision loss

flashing lights (photopsia)

double vision

retrobulbar pain

pulsatile tinnitus

Question 22

Diagnostics of pseudomotor cerebri

Answer 22

high opening CSF pressure

Normal CSF analysis

6th nerve palsy

Bilateral papilledema

Question 23

chronically elevated ICP in absence of ventricular enlargement or ass lesion

Answer 23

Pseudomotor cerebri

Question 24

contraindications of IV mannitol to reduce elevated ICP

Answer 24

anuria

progressive heart failure

severe pulmonary edema

severe pre-existing dehydration

Question 25

Normal ICP

Answer 25

~15cm H20