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Neurology > Intracranial Pressure Pathology > Flashcards

Intracranial Pressure Pathology Flashcards

1
Q

What is raised intracranial pressure e

A

Increase in the volume or mass of intracranial content within fixed capacity of skull which displaces CSF and compress the vasculature leading to increased pressure in cranial cavity

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2
Q

What is the capacity of the skull

A

Less than 30 cubic cm

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3
Q

Intracranial compartment division with percentages

A

Brain - 85%
Blood - 10%
CSF - 5%

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4
Q

Normal pressure in skull

A

10-15 mmHg

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5
Q

Upper normal limit of IC pressure

A

20 mm Hg

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6
Q

Moderate increase in IC pressure

A

20-40 mmHg

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7
Q

Severe increase in IC pressure

A

More than 40 mmHg

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8
Q

Causes of raised IC pressure

A

Intracranial expanding lesions like tumor , hematoma , abscess, granuloma, swollen infarct

Infections - meningitis , encephalitis

Hydrocephalus

Cerebral edema

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9
Q

What is hydrocephalus

A

Accumulation of excessive CSF in ventricular system

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10
Q

Specialized tissue that secretes CSF

A

Choroid plexus

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11
Q

Where is choroid plexus located

A

Lateral ventricle
Third ventricle
Fourth ventricle

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12
Q

Amount of CSF at all times

A

150-270 ml

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13
Q

Which structures on choroid plexus secretes the CSF

A

Villi

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14
Q

Circulation of CSF

A

Lateral ventricle -> inter ventricular foramen ->third ventricle -> cerebral aqueduct -> 4th ventricle ->

4th ventricle -> some go through obex narrow passage -> central canal

4th ventricle -> majority pass through median aperture and 2 lateral apertures -> cisterns magna and cerebelli pontine cisterns -

-> subarachnoid space of the brain and spinal cord -> reabsorption into Dural venous sinuses through arachnoid granulations

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15
Q

Absorption of CSF

A

Majority by arachnoid granulation which have arachnoid villi which pierce into dural venous sinuses

Minute channels in the cribiform plate and drain into lymphatic channels of nasal mucosa

Glymphatic system

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16
Q

Hydroc

A
17
Q

Hydrocephalus causes

A

Overproduction of CSF by choroid plexus papilloma / hyperplasia

Obstruction to flow

Defective absorption - arachnoid villous fibrosis / destruction , sinus thrombosis

18
Q

Types of hydrocephalus

A

Communicating
Non communicating
Hydrocephalus ex vacuo

19
Q

What is hydrocephalus ex vacuo

A

Brain damage due to stroke or injury with brain substance shrinkage
Leads to filling of extra spACE by CSF
With normal CSF pressure and enlarged ventricles

20
Q

People at risk of hydrocephalus ex vacuo

A

Very old persons
Alzheimer’s patients
People with degenerative disease of Brian

21
Q

When do you see hydrocephalus in children

A

Before suture close or after

22
Q

When do you see hydrocephalus in adults

A

After suture closure

23
Q

Cerebral edema can be caused by raised intracranial pressure T or F

A

True

24
Q

3 types of cerebral edema

A

Cytotoxic
Vasogenic
Interstitial

25
Q

Cytotoxic cerebral edema

A

Intracellular , due to cell swelling

Seen in hypoxia when pump cant work to move sodium

26
Q

Vasogenic edema

A

Extracellular
BBB is disrupted
Affect white matter via leakage of fluid from capillaries

27
Q

Interstitial edema

A

Periventricular

Increased in brain fluid due to blockage of CSF flow

28
Q

How can we evaluate the clinical consequences of the raised ICP

A

Degree or severity of increased intracranial pressure
Rates and speech of increased intracranial pressure
Nature of underlying reason leading to raise intracranial pressure

29
Q

What are the different raised intracranial pressure effects

A

Spatial compensation
alterations in the brain
herniation
systemic effects

30
Q

What are the different spatial compensation effects

A

Expanding lesions leading to compression and reduced csf volume

Reduce blood flow

31
Q

What are the different alteration in the brain

A

Focal or localized destruction of neurons -> direct pressure effects
generalized neuronal degeneration with diffuse compression of blood vessels leading to ischemia

Brain tissue displacement with HERNIATION

Cranial nerve pressure creating cranial nerve palsies

Compression of intracranial vessels leading to kinking of vessels

Infarct
hemorrhage

32
Q

Major her nations of the brain

A

Sub falcine herniation
transtentorial HERNIATION

cerebellar tonsi HERNIATION in foramen magnum

33
Q

Clinical effects of Sub falcine herniation

A

Compression of anterior cerebral artery branches

34
Q

Clinical effects of transtentorial HERNIATION

A

Third cranial nerve compromised leading to ocular changes

ischemia in the posterior cerebral artery affecting visual cortex

compression of contralateral cerebellar peduncle leading to hemiparesis

hemorrhages in the brainstem known as duret

35
Q

Tonsillar herniation clinical effect

A

Compromises respiratory and cardiac centers

36
Q

Systemic effects of raised intracranial pressure

A

Arterial hypertension because of local sympathetic activity

myocardial dysfunction damage ,necrosis ,subendocardial hemorrhage

respiratory dysfunction with damage to brainstem

Mucosal alterations in the G.I. tract and urinary system Due to increased sympathetic activity

Neurology (31 decks)

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