Raised ICP Flashcards
Signs of raised ICP
Headache
Vomiting
Papilloedema
Reduced GCS
Seizures
Pupil changes
Cushing’s triad
When is raised ICP headache worse
Waking
Lying down
Bending forward
Coughing
Signs of space occupying lesion
Raised ICP
Seizures
Focal neurology
Subtle personality change
Causes of SOL
Tumour
Aneurysm
Abscess
Chronic subdural haematoma
Types of primary brain tumour
Astrocytoma
Glioblastoma
Oligodendroglioma
Ependymoma
Meningioma
Metastatic brain tumours
Breast
Lung
Melanoma
Mx of hydrocephalus
Ventriculo-Peritoneal shunt
(VP shunt)
Third ventrical colloid cyst definition
Congenital cysts
Present in adulthood
Presentation of Third ventrical colloid cysts
Amnesia
Headache
Incontinence
Bilateral paraesthesia
Blunted consciousness
Mx of Third ventrical colloid cyst
Excision
VP shunt
Idiopathic intracranial hypertension presentation
Same as SOL but absence of mass
Narrowed visual fields
Consciousness and cognition preserved
Typical patients with idiopathic intracranial hypertension
Obese women
Causes of idiopathic intracranial hypertension
Unknown
Secondary to venous sinus thrombosis
Drugs
Drug causes of idiopathic intracranial hypertension
Tetracycline
Nitrofurantoin
Vit A
Isotretanoin
Mx of idiopathic intracranial hypertension
Weight loss
Acetazolamide
Loop diuretics
Prednisolone
Prognosis of idiopathic intracranial hypertension
Often self limiting
10% permanent significant visual loss
Mx options for visual disturbance
Lumbar-peritoneal shunt
Optic nerve sheath fenestration
Temporal lobe focal neurology
Dysphagia
Contralateral homonymous hemianopia
Amnesia
Frontal lobe focal neurology
Hemiparesis
Personality changes
Broca’s dysphasia
Unilateral anosmia
Perseveration
Parietal lobe focal neurology
Hemisensory loss
Dysphasia
Occipital lobe focal neurology
Contralateral visual field defects
Cerebellum focal neurology
DANISH P
Dysdiadochokinesis
Ataxia
Nystagms
Intention tremor
Slurred speech
Hypotonia
Past pointing
Sx of cerebral abscess
Raised ICP
Fever
Coma
Sepsis
Mx of cerebral abscess
Urgent neurosurgery referral
Rx raised ICP
Cushing’s triad definition
Late sign of raised ICP
Worried about coning
Cushing’s triad
Bradycardia
HTN
Cheyne-Stokes respiration
Cheyne-Stokes respiration
Irregular breathing
Causes of raised ICP
Tumours
Head injury
Haemorrhage
Infection
Hydrocephalus
Status epilepticus
Mx of raised ICP
Urgent neurosurgery referral
Lift head of bed
Hyperventilate
Osmotic agents (mannitol)
Fluid restriction
Reason for hyperventilation to rx raised ICP
Reduced CO2
Cerebral vasoconstriction
Reduced ICP immediately
Level of fluid restriction for raised ICP
< 1.5 L/day
Uncal herniation
lateral supratentorial mass
3rd nerve palsy
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Cerebellar tonsil herniation
Cerebellar tonsils through foramen magnum
Sx of cerebellar tonsil herniation
Ataxia
6th nerve palsy
Upgoing plantars
LOC
Irregular breathing
Subfalcian (cingulate) herniation
Cingulate gyrus forced under rigid falx cerebri
ACA compressed causes stroke
Definition of encephalitis
Infection of brain
Sx of encephalitis
Confusion
Reduced GCS
Fever
Headache
Focal neurology
Seizures
Viral causes of encephalitis
HSV 1 and 2
Arboviruses
CMV
EBV
VZV
HIV seroconversion
Measles
Mumps
Japanese B encephalitis
I can’t even think of any more viruses
Non viral causes of encephalitits
Bacterial meningitis
TB
Malaria
Lyme disease
Leptospirosis
Ix for encephalitis
Blood cultures
Serum viral PCR
Malaria film
CT
LP
CT findings in encephalitis
Focal bilateral temporal lobe involvement suggestive of HSV encephalitis
LP findings in encephalitis
Increased protein
Increased lymphocytes
Decreased glucose
Send CSF for viral PCR
Mx of encephalitis
Aciclovir 14 days
Causes of subarachnoid haemorrhage
Saccular aneurysm rupture
Arteriovenous malformation
Indiopathic
Associations of berry aneurysms
Polycystic kidney disease
Aortic coarctation
Ehlers-Danlos syndrome
RFs for subarachnoid haemorrhage
Smoking
Alcohol misuse
HTN
Bleeding disorders
Ehlers-Danlos syndrome features
Hypermobile joints
Increased skin elasticity
Sx of subarachnoid haemorrhage
Sudden onset
Thunderclap occipital headache
Vomiting
Signs of subarachnoid haemorrhage
Neck stiffness
Seizure
Collapse
Sentinel headache definition
Early small warning headache before subarachnoid haemorrhage
Warning leak
Ix for subarachnoid haemorrhage
CT within 48 hrs
LP > 12 hrs if CT negative
LP findings in subarachnoid haemorrhage
Xanthochromia is pathopneumonic
CSF is yellow after several hrs from Hb breakdown
Shows blood in CSF is not from LP
Mx of subarachnoid haemorrhage
Neurosurgery referral
Hydration
Nimodipine
Endovascular coiling
Use of nimodipine for subarachnoid haemorrhage
Ca channel blocker
Reduces cerebral vasospasm and therefore cerebral ischaemia
Complications of subarachnoid haemorrhage
Rebleeding
Cerebral ischaemia
Hydrocephalus
Hyponatraemia