Intracranial Pressure

Question 1

RAISED INTRACRANIAL PRESSURE

Answer 1

1. CN VI palsy is common
2. Headache
   - Can be intermittent with loss of consciousness upon coughing/straining –> intraventricular tumours
3. Ataxia
4. Confusion, drowsiness
5. Coma
6. Papilloedema if long-standing
7. CN III palsy
   - temporal lobe herniation
8. Medullary involvement
   - Rise in systolic BP
   - Reduction in pulse

Question 2

LOW INTRACRANIAL PRESSURE:

Answer 2

1. Headache on standing
2. CSF rhinorrhoea
   - associated with recurrent meningitis
3. CN VI palsy
4. MRI scanning with gadolinium
   - Marked dural enhancement
5. Causes:
   - CSF leakage through torn meninges, commonly caused by trauma, iatrogenic and tumours
   - Spontaneous intracranial hypotension

Question 3

HERNIATION:

Answer 3

1. Tentorium
   - affects CN III involving pupils
   - Affects midbrain causing coma, pupillary changes and tetraparesis
   - Compresses posterior cerebral artery leading to occipital infarction, increasing supratentorial pressure and increasing the herniation
   - death
2. Foramen magnum
   - Severe neck pain, erratic breathing, progressing tetraparesis, coma
   - death

Question 4

TREATMENT:

Answer 4

1. Hyperventilation
2. Steroids
   - help reduce cerebral oedema
3. Neurosurgery
   - Surgical decompression
   - Shunting
   - Drainage
4. Mannitol
   - Decrease brain swelling