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N - C > Intracranial Pressure > Flashcards

Intracranial Pressure Flashcards

1
Q

What is the best eye response in the GCS?

A

Open spontaneously (4)

Open to verbal command (3)

Open to pain (2)

Does not open eyes (1)

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2
Q

What is the best verbal response in the GCS?

A 
Oriented (5)
Confused speech (4)
Inappropriate words (3)
Incomprehensible sounds (2)
No speech (1)
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3
Q

What is the best motor response in the GCS?

A 
Obeys commands (6)
Localised to pain (5)
Normal flexion to pain (4)
Abnormal flexion to pain (3)
Extension to pain (2)
No movement (1)
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4
Q

What classifies a coma?

A

GCS score of 8 or less

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5
Q

Describe the physiological processes in raised ICP

A

Haemorrhage (“mass effect”)

Disruption of blood brain barrier -> Increased ECF
(Vasogenic Oedema)

Membrane Failure -> influx of Ca -> cellular swelling (cytotoxic oedema)

Influx of inflammatory mediators

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6
Q

What are the secondary effects of raised intracranial pressure

A

Anatomical
-Herniation syndromes

Cellular
-Decreased cerebral perfusion

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7
Q

What is the Monro-Kellie Doctrine?

A

Brain exists in a fixed intracranial space which is a constant.

This constant is filled with CSF, Blood, Brain, and other

If other increases the something else has to decrease to keep same volume

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8
Q

How is a haematoma compensated for initially preventing a large increase in ICP?

A

Interstitial fluid is squeezed out

CSF shunted into thecal sac

Blood shunted out of head via internal jugular vein

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9
Q

What causes the lucid interval in jead trauma?

A

Compensatory measures by shunting CSF, Blood and squeezing interstitial fluid out.

This doesnt last for ever and you get rapid increase in ICP and drop in consciousness

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10
Q

How is cerebral perfusion pressure calculated?

A

MAP - ICP = CPP

MAP battles against ICP to keep CPP.
If ICP increases CPP will decrease

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11
Q

How is MAP calculated?

A

Diastolic BP + 1/3 pulse pressure

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12
Q

What is the normal CPP?

A

80 mmHg

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13
Q

What is the normal MAP?

A

90mmHg

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14
Q

What is the normal ICP?

A

5-15mmHg

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15
Q

How much cardiac output does the brain receive?

A

15%

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16
Q

What is the oxygen consumption of the brain?

A

High

20% total body consumption

17
Q

How do neurones produce ATP?

A

Almost entirely by oxidative metabolism of substrates including glucose and ketone bodies, little capacity for anaerobic metabolism

18
Q

How quickly do energy dependent processes cease without oxygen in the brain?

A

3-8 minutes

Irreversible cellular injury

19
Q

Name the methods of regulation of cerebral blood flow

A

Autoregulation (myogenic)

Cerebral metabolism

Carbon dioxide and oxygen

Neurohumoral factors

20
Q

Describe the myogenic mechanism in autoregulation of cerebral blood flow

A

vascular smooth muscle constricts in response to an increase in wall tension

21
Q

For vision the optic tract synapses in the lateral geniculate nucleus.
Where does it synpase in pupil constriction?

A

Some fibres given off optic tract to pretectal nucleus and onto oculomotor nerve

22
Q

Why does the pupil fix and dilate in head trauma?

apart from trauma to the orbit

A

Raised ICP may push temporal lobe over and this will herniate through tantrum cerebellum and will press on the oculomotor nerve
(Uncal Herniation)

23
Q

What is an Uncal Herniation?

A

Temporal lobe presses on oculomotor nerve and ipsilateral corticospinal tracts

24
Q

What is a subfalcine herniation?

A

Cortex is pushed under falx cerebri

Medial motor corex affected

25
Q

What is Foramen magnum herniation?

A

Brain stem centres herniate through foramen magnum

26
Q

Why does calling an anethetist to enduce hyperventilation help with raised ICP?

A

Hyperventilation decreases CO2

This is picked up by the carotid body

Bloodflow is reduced

ICP lowers

27
Q

Why can raised ICP enter a vicious cycle?

A
  • Raised ICP
  • Decreased Cerebral Blood Flow
  • Tissue hypoxia
  • Increased CO2 and decreased pH
  • Cerebral vasodilation and oedema
  • Raised ICP
28
Q

What is mannitol?

A

Osmotic diuretic

Very useful
“Dries out the brain”

29
Q

What are a neurosurgeons options for interventions in raised ICP?

A

Craniotomy an ecavuation of clot

External ventricular drainage

Decompressive craniectomy

N - C (35 decks)

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