Raised ICP

Question 1

Variation of features of early raised ICP

Answer 1

Progress from initial mild non-specific symptoms, to late stage significant symptoms.

Question 2

Symptoms of early raised ICP

Answer 2

Morning headache, worse when coughing or exertion, vomiting with no nausea, lethargy, altered mental state. Ocular palsies, papilloedema or pupil abnormalities

Question 3

Late symptoms of raised ICP

Answer 3

Persistant vomiting, ophthalmoplegia, Cushing’s triad, eventual coma and death

Question 4

Causes of raised ICP

Answer 4

Traumatic brain injury, hydrocephalus, SOLs, subarachnoid haemorrhage, idiopathic intracranial hypertension, Reye’s syndrome

Question 5

Diagnosis of raised ICP

Answer 5

CT head

Question 6

Treatment of raised ICP

Answer 6

Treat underlying cause - clot evacuation for haemorrhage, surgery, chemo for cancer, Abx for infection

Question 7

Contraindications for monitoring ICP

Answer 7

Coagulopathies, anti-coagulation medications, scalp infection or abscess

Question 8

3 ways to monitor ICP

Answer 8

External ventricular drain, subarachnoid bolt, epidural bolt

Question 9

Acute management of raised ICP

Answer 9

Hypertonic saline, elevate bed to 40 degrees

Question 10

Type of headache in idiopathic IC hypertension

Answer 10

Non-pulsatile, bilateral, worse in morning

Question 11

Visual disturbances in idiopathic IC hypertension

Answer 11

Transient visual darkening or loss, bilateral papilloedema

Question 12

Drug associations with idiopathic IC hypertension

Answer 12

OCP, steroids, tetracycline, Vit A, lithium

Question 13

Management of idiopathic IC hypertension

Answer 13

Weight loss, azetazolamide but poorly tolerated, protect against vision loss

Question 14

Differentials for space occupying lesion

Answer 14

Tumours, vascular lesions, infections and granulomata

Question 15

Infective causes of space occupying lesions

Answer 15

Cerebral abscess, TB, cysticercosis, amoebiasis, infections from middle or inner ear, mastoiditis

Question 16

Features of SOL

Answer 16

Headache worse when lying down, couhging, straining and may be associated with vomiting. Cranial nerve palsies, especially abducens, drowsiness, seizures, cushings reflex

Question 17

How can raised ICP cause a secondary brain injury

Answer 17

Can reduce blood flow to the brain, which is why BP is high to keep brain perfused

Question 18

What is the Monro-Kellie hypothesis

Answer 18

The sum of the brain, CSF and intracerebral blood is constant, so an increase in one should cause a reciprocal decrease in either one of the remaining two

Question 19

Why is headache worse in the morning from a raised ICP

Answer 19

From slowed breathing, increase in CO2, vasodilation and increased blood flow to the brain. This is also due to the fact that the patient is lying down and venous drainage is less than if stood up.