Increased ICP versus Hydrocephalus

Question 1

EARLY signs of hydrocephalus in an INFANT

Answer 1

Rapid head growth, full bulging fontanel, irritability, poor feeding, distended prominent scalp veins, widely separated cranial sutures.

Question 2

LATE signs of hydrocephalus in an INFANT

Answer 2

sun-setting eyes, frontal bone enlargement/bossing, vomiting, difficulty swallowing or feeding, increased BP, decreased HR, altered restorations, shrill high pitched cry, sluggish or unequal pupillary responses.

Question 3

EARLY signs of hydrocephalus in a CHILD

Answer 3

Strabismus, headache (in the morning relieved with vomiting or sitting up), nausea and vomiting (projectile), restlessness, diplopia, behavior or personality changes, ataxia, sluggish or unequal pupils, confusion, changes in school work, lethargy.

Question 4

LATE signs of hydrocephalus in a CHILD

Answer 4

Seizures, increased BP, decreased HR, altered respirations, blindness from herniation of the optic disc, and decerebrate rigidity

Question 5

EARLY signs of Increased ICP in an INFANT

Answer 5

Tense, bulging fontanels, separated cranial sutures, distended scalp veins, drowsiness, poor feeding, and high pitched cry.

Question 6

EARLY signs of increased ICP in a CHILD

Answer 6

Headache, nausea and vomiting, seizures, blurred or double vision, lethargy or increased sleepiness.

Question 7

LATE signs of increased ICP (infants and children)

Answer 7

Posturing (decorticate, decerebrate), bradycardia, increased BP, alterations in pupil size, Cheyne-stokes respirations, decreased consciousness, and coma 1-8 (GCS).

Question 8

What are the clinical manifestations of a neurological emergency?

Answer 8

Asymmetrical pupils, one dilated nonreactive pupil, widening pulse pressure, deep periodic or gasping respirations, slowing pulse. (think about brainstem herniation)

Question 9

What vital sign changes might you see with increased ICP?

Answer 9

HR–Rapid or slow and bounding
Respirations–slow, deep, irregular
BP–an increased BP and slowed pulse could be Cushing’s response (indicates impending brainstem herniation)
Temp–Hypothalamus damage
Pupils–dilation occurs on the same side as the pressure.

Question 10

Full consciousness

Answer 10

awake, alert, oriented, interacts with environment

Question 11

Confused

Answer 11

lacks ability to think clearly and rapidly

Question 12

Disoriented

Answer 12

lacks ability to recognize place or person

Question 13

Lethargic

Answer 13

awakens easily but exhibits limited responsiveness

Question 14

Obtunded

Answer 14

Sleeps unless aroused, once aroused has limited interaction with environment

Question 15

Stupor

Answer 15

requires considerable stimulation to arouse

Question 16

Coma

Answer 16

vigorous stimulation produces no motor or verbal response