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Neurology > Raised ICP > Flashcards

Raised ICP Flashcards

1
Q

What is required for full evaluation in an acute intracranial event?

A

History - onset, pattern of change, previous episodes

Examination- GCS, neurological, CVS

Investigations - target to differential diagnoses, CT scan in uncertainty

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2
Q

Causes of lack of blood to the brain?

A

Blockage in vessels due to plaque, thrombus, embolism -> ischaemic stroke

Systemic hypotension

Raised ICP

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3
Q

What can raise ICP?

A

Brain swelling
Space-occupying mass
Blockage of CSF circulation

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4
Q

Why can fitting mean that the brain’s requirement for nutrients is not met?

A

Brain has an increased metabolic requirement

However contraction of muscles and lack of proper function of respiratory muscles may not be met

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5
Q

How can a head injury lead to fitting?

A

Disturb the reticular activating system

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6
Q

What are the factors used to tell if a head injury is serious?

A

Mechanism of injury

Signs of brain injury - changes in consciousness and focal neurology

Pattern of change

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7
Q

What is the primary brain injury?

A

Injury sustained at the time of impact

-normally due to movement of brain inside the skull

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8
Q

What makes a primary brain injury worse?

A

If the head is moving and hits an object means movement is greatest (rather than an object hitting the head)

When movement is front to back rather than side to side, can cause more damage

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9
Q

Initial assessment in a head trauma?

A 
Airway
Breathing
Circulation
Disability - AVPU, GCS
Need for advanced life support?
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10
Q

What is an extra-axial haemorrhage?

A

Bleeding within the skull but outside the brain tissue

  • subarachnoid
  • subdural
  • extradural
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11
Q

What happens in a subarachnoid haemorrhage?

A

Spontaneous arterial bleeding into the subarachnoid space

Usually due to saccular (berry) aneurysms and arteriovenous malformations

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12
Q

Symptoms of a subarachnoid haemorrhage?

A

Thunderclap headache - rapid onset of a severe headache

Vomiting
Coma
Neck stiffness

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13
Q

Where do berry aneurysms develop?

A

On the circle of Willis and adjacent arteries - can cause symptoms of rupture or compression on surrounding structures

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14
Q

What are arteriovenous malformations?

A

Collection of arteries and veins of developmental origin

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15
Q

What is seen on a CT of a subarachnoid haemorrhage?

A

Intraventricular or subarachnoid blood

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16
Q

Differential diagnoses of subarachnoid haemorrhage?

A

Severe migraine

Bacterial meningitis

17
Q

Complication of a subarachnoid haemorrhage?

A

Communicating hydrocephalus - occluded CSF reabsorption

Can cause deterioration of consciousness

18
Q

Management of a SAH?

A

Bed rest
Supportive treatment
Referral to a specialist for neurosurgery

19
Q

What is a subdural haematoma?

A

Accumulation of venous blood in the subdural space following rupture of a bridging vein

20
Q

What can precipitate a subdural haematoma?

A

Head injury

Spontaneous SDH common in elderly and alcoholics

21
Q

Clinical features of subdural haematoma?

A

Initial trauma and potential temporary loss of consciousness

Headache
Drowsiness
Confusion
Focal deficits such as
-hemiparesis
-sensory loss

Stupor and coma may subsequently develop

22
Q

Management of a subdural haematoma?

A

Refer for neurosurgery

Can resolve naturally

23
Q

What is seen on a CT scan of a subdural haematoma?

A

Lens-shaped appearance

24
Q

What is an extradural haematoma?

A

Accumulation of blood rapidly in the outside dura

25
Q

What is the underlying cause of an extradural haematoma?

A

Damage to the anterior branch of the middle meningeal artery following trauma to the temporal region with subsequent fracture of the pterion

26
Q

Clinical features of an extradural haematoma?

A 
Lose consciousness
Lucid interval in recovery
Develop progressive hemiparesis and stupor 
Rapid tentorial or tonisllar herniation 
Ipsilateral pupil dilation 
Respiratory arrest
27
Q

What is seen on the CT of an extradural haematoma?

A

Lemon-shaped bleed

28
Q

Management of an extradural haematoma?

A

Neurosurgery to drain the blood and relieve compression of the brain

29
Q

What are the three types of internal herniation in the brain?

A

Subfalcine
Tentorial
Tonsilar

30
Q

What happens in a subfalcine herniation?

A

Occurs on the same side as the mass

Cingulate gyrus is pushed under the free edge of the falx cerebri

31
Q

What does a subfalcine herniation result in?

A

Ischaemia of the medial parts of the frontal and parietal lobe and of the corpus callosum
Due to compression of the anterior cerebral artery

32
Q

What happens in a tentorial herniation?

A

The uncus/medial part of the parahippocampal gyrus passes through the tentorial notch

33
Q

What does a tentorial herniation result in?

A

Damage of the oculomotor nerve on the same side
Compression of the cerebral peduncles
Occlusion of blood flow in the posterior and superior cerebellar arteries
Haemorrhage into brainstem -> fatal

34
Q

What is Cushing’s reflex and in which brain herniation is it commonly seen in?

A

Bradycardia with severe hypertension - because the body is trying to restore blood to the area of the brain being compressed

Tentorial hernia

35
Q

What is a common cause of a tentorial hernia?

A

Brain tumour

Intracranial haemorrhage

36
Q

What happens in a tonsillar haemorrhage?

A

The cerebellar tonsils are pushed into the foramen magnum, compressing the brain stem

37
Q

What are the clinical consequences of RICP or herniation?

A

Prodromal phase

  • headache
  • vomiting
  • papilloedema

Acute phase

  • oculomotor nerve compression - pupil dilation
  • compression of brain stem - coma

Compression of cerebral peduncles

  • hemiparesis
  • decerebrate rigidity

Further herniation

  • apnoea
  • cardiac arrest (compression of brainstem structures)
38
Q

If a patient survives an initial raised ICP, what are they then at risk of?

A

Neurological deficit
Infection
Epilepsy
Chronically raised pressure of scarring has impaired CSF circulation

Neurology (20 decks)

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