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Neurology > raised ICP, Brain Herniations, haemorrhage > Flashcards

raised ICP, Brain Herniations, haemorrhage Flashcards

1
Q

effect of ↑ICP on CCP?

A

↓cerebral perfusion pressure

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2
Q

mortality rate of raised ICP?

A

20%

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3
Q

what the three brain volumes?

how many mls does each take?

A

o Brain 1300ml
o CSF 130 ml
o Blood 130 ml

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4
Q

what is Normal ICP?

A

7-15mmHg

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5
Q

what does ICP stand for?

units?

A

intracranial pressure

mmHg

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6
Q

how much pressure is Abnormal ICP?

A

> 15mmHg

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7
Q

how much pressure is pathological ICP?

A

> 20mmHg

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8
Q

how does standing effect ICP?

A

decreases ICP

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9
Q

how is CCP calculated?

what does CCP stand for?

A

MAP – ICP

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10
Q

which hypothesis from Edinburgh describes how brain volumes behave?

and what exactly does this hypothesis state?

A

Monro Kellie hypothesis

if volume of one of the cranial constituents increases, this must be compensated by a decrease in volume of another

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11
Q

what term is used when there is too much CSF?

A

hydrocephalus

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12
Q

what pathological thing could increase CSF production?

A

tumour choroid plexus

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13
Q

why is there a headache with ↑ICP?

A

brain pushed out –> meninges sensitive to pain pushed –> headache caused

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14
Q

a pt has raised ICP.

how will their the severity of their headaches change during the day, i.e. when is it worst?

explain why?

A

worse in morning

lying down naturally increases ICP (no gravity)

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15
Q

a pt has raised ICP and is vomiting.

explain why?

A

↑ICP – vagus nerve pushed on and stimulated –>(vagus nerve innervates stomach), vomiting caused.

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16
Q

pt has raised ICP.

what is seen on ophthalmoscope?

A

papilloedema (big optic disk)

↑ICP – arteries give blood to eye, but high ICP presses on veins stopping venous drainage –> fluid leaks out, oedema.

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17
Q

what is the classic triad of high ICP called?

what is the triad?

A

Cushing’s Triad

HTN, bradycardia, bradypnoea

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18
Q

what is the classic triad of high ICP called?

explain each component of the triad.

A

↑ICP – brain not perfused & ischaemic, brain tells hypothalamus to drive SNS, arteries vasoconstrict, ↑HTN.

↑HTN – body now tries to compensate for this by reducing heart rate.

↑ICP – respiratory centre in medulla pushed on, bradypnoea.

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19
Q

where is the respiratory centre in the brain located?

A

medulla

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20
Q

what are the brain causes for a raised ICP?

  • (i.e. what can increase brain volume)
  • 4
A 
tumour
abscesses
oedema
blood in brain tissue: 
•	haemorrhage
•	ruptured aneurysm
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21
Q

what are the main signs for raised ICP?

-2

A

Papilloedema

↓GCS

22
Q

asides from the triad what are two main symptoms?

A

Headaches

Vomiting

23
Q

last resort surgery for ↑ICP?

A

Decompressive craniectomy

24
Q

procedure for hydrocephalus?

A

Extraventricular drains

25
Q

main drug for raised ↑ICP?

26
Q

what is a very quick very easy management step anyone can do for ↑ICP?

A

Raise head

27
Q

primary IX?

-2

28
Q

what is coning?

what are two other names for this problem?

A

cerebellum moves down foramen magnus, brainstem compressed.

Tonsillar Herniation
Chiari syndrome

29
Q

which type of haematoma causes a thunderclap headache?

A

Subarachnoid

30
Q

which type of haematoma occurs from meningeal arteries bursting?

31
Q

which type of haematoma occurs from meningeal bridging veins tearing?

32
Q

which hematoma has a lemon shape?

33
Q

which hematoma has a banana shape?

34
Q

what are the two usual causes for subarachnoid haemorrhage?

A

rupture cerebral aneurysm

trauma

35
Q

which haematoma has slow onset of symptoms?

which blood vessels are damaged in said haematoma. arteries, vein or capillaries?

A

Subdural

veins

36
Q

how long is a chronic subdural?

hyow does this look on CT?

A

1 week

blood gets darker on CT over time

37
Q

pt has a lucid period before their symptoms.

what haematoma is this?

why does this lucid pain happen?

A

Epidural

Lucid period is brain compensating pressure

38
Q

what are the two commonly used surgery options for treating epidural?

difference between them?

which has a longer recovery?

A

craniotomy/burr hole

burr hole - smaller hole, quicker recover
craniotomy - bigger hole, longer recovery

39
Q

what is usual cause for a subarachnoid haemorrhage?

40
Q

in subarachnoid haemorrhages (SAH),

cause has two categories, what are they?

most common cause for each category?

A

traumatic SAH - trauma

spontaneous SAH - burst berry aneurysm

41
Q

risk factors for a subarachnoid haemorrhage?

- 6

A 
o	Age 
o	HTN 
o	Smoking 
o	FHx 
o	Polycystic kidney disease 
o	Alcohol excess
42
Q

Aneurysm at P comm A presses on what nerve?

how will this manifest?

A

3rd nerve

3rd nerve palsy, down and out

43
Q

where is most common location for a burst berry aneurysm?

A

o Junction between anterior communicating artery and

anterior cerebral artery

44
Q

what are the causes for a spontaneous SAH?

-5

A
  • Burst berry aneurysm
  • AV malformation
  • Mycotic aneurysm
  • Vertebra artery dissection
  • Tumour
45
Q

when CSF is yellow on LP,

what is it called?

how does this happen in the context of haemorrhage?

how long does it take for above to happen post-bleed?

A

xanthochromia

haemoglobin breakdown to bilirubin

12 hours

46
Q

where does blood collect in the subarachnoid space?

A

Basal cisterns

47
Q

acute drug for SAH?

A

Nimodipine

48
Q

Nimodipine moa?

how will this help in SAH?

A

blocks L-type Ca2+ channels on vascular smooth muscle cells

stops vasospasm

49
Q

SAH can cause what to ICP?

A

raised, hydrocephalus

50
Q

why can SAH raise ICP?

A

blood leaks into ventricles

51
Q

ultimate treatment for SAH?

A

surgery - put coil in aneurysm

52
Q

drug you give for raised ICP?

Neurology (40 decks)

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