Raised ICP Flashcards
What is required for full evaluation in an acute intracranial event?
History - onset, pattern of change, previous episodes
Examination- GCS, neurological, CVS
Investigations - target to differential diagnoses, CT scan in uncertainty
Causes of lack of blood to the brain?
Blockage in vessels due to plaque, thrombus, embolism -> ischaemic stroke
Systemic hypotension
Raised ICP
What can raise ICP?
Brain swelling
Space-occupying mass
Blockage of CSF circulation
Why can fitting mean that the brain’s requirement for nutrients is not met?
Brain has an increased metabolic requirement
However contraction of muscles and lack of proper function of respiratory muscles may not be met
How can a head injury lead to fitting?
Disturb the reticular activating system
What are the factors used to tell if a head injury is serious?
Mechanism of injury
Signs of brain injury - changes in consciousness and focal neurology
Pattern of change
What is the primary brain injury?
Injury sustained at the time of impact
-normally due to movement of brain inside the skull
What makes a primary brain injury worse?
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
Initial assessment in a head trauma?
Airway Breathing Circulation Disability - AVPU, GCS Need for advanced life support?
What is an extra-axial haemorrhage?
Bleeding within the skull but outside the brain tissue
- subarachnoid
- subdural
- extradural
What happens in a subarachnoid haemorrhage?
Spontaneous arterial bleeding into the subarachnoid space
Usually due to saccular (berry) aneurysms and arteriovenous malformations
Symptoms of a subarachnoid haemorrhage?
Thunderclap headache - rapid onset of a severe headache
Vomiting
Coma
Neck stiffness
Where do berry aneurysms develop?
On the circle of Willis and adjacent arteries - can cause symptoms of rupture or compression on surrounding structures
What are arteriovenous malformations?
Collection of arteries and veins of developmental origin
What is seen on a CT of a subarachnoid haemorrhage?
Intraventricular or subarachnoid blood
Differential diagnoses of subarachnoid haemorrhage?
Severe migraine
Bacterial meningitis
Complication of a subarachnoid haemorrhage?
Communicating hydrocephalus - occluded CSF reabsorption
Can cause deterioration of consciousness
Management of a SAH?
Bed rest
Supportive treatment
Referral to a specialist for neurosurgery
What is a subdural haematoma?
Accumulation of venous blood in the subdural space following rupture of a bridging vein
What can precipitate a subdural haematoma?
Head injury
Spontaneous SDH common in elderly and alcoholics
Clinical features of subdural haematoma?
Initial trauma and potential temporary loss of consciousness
Headache Drowsiness Confusion Focal deficits such as -hemiparesis -sensory loss
Stupor and coma may subsequently develop
Management of a subdural haematoma?
Refer for neurosurgery
Can resolve naturally
What is seen on a CT scan of a subdural haematoma?
Lens-shaped appearance
What is an extradural haematoma?
Accumulation of blood rapidly in the outside dura
