raised ICP, Brain Herniations, haemorrhage

Question 1

effect of ↑ICP on CCP?

Answer 1

↓cerebral perfusion pressure

Question 2

mortality rate of raised ICP?

Answer 2

20%

Question 3

what the three brain volumes?

how many mls does each take?

Answer 3

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

Question 4

what is Normal ICP?

Answer 4

7-15mmHg

Question 5

what does ICP stand for?

units?

Answer 5

intracranial pressure

mmHg

Question 6

how much pressure is Abnormal ICP?

Answer 6

> 15mmHg

Question 7

how much pressure is pathological ICP?

Answer 7

> 20mmHg

Question 8

how does standing effect ICP?

Answer 8

decreases ICP

Question 9

how is CCP calculated?

what does CCP stand for?

Answer 9

MAP – ICP

Question 10

which hypothesis from Edinburgh describes how brain volumes behave?

and what exactly does this hypothesis state?

Answer 10

Monro Kellie hypothesis

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

Question 11

what term is used when there is too much CSF?

Answer 11

hydrocephalus

Question 12

what pathological thing could increase CSF production?

Answer 12

tumour choroid plexus

Question 13

why is there a headache with ↑ICP?

Answer 13

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

Question 14

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?

Answer 14

worse in morning

lying down naturally increases ICP (no gravity)

Question 15

a pt has raised ICP and is vomiting.

explain why?

Answer 15

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

Question 16

pt has raised ICP.

what is seen on ophthalmoscope?

Answer 16

papilloedema (big optic disk)

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

Question 17

what is the classic triad of high ICP called?

what is the triad?

Answer 17

Cushing’s Triad

HTN, bradycardia, bradypnoea

Question 18

what is the classic triad of high ICP called?

explain each component of the triad.

Answer 18

↑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.

Question 19

where is the respiratory centre in the brain located?

Answer 19

medulla

Question 20

what are the brain causes for a raised ICP?

• (i.e. what can increase brain volume)
• 4

Answer 20

tumour
abscesses
oedema
blood in brain tissue: 
•	haemorrhage
•	ruptured aneurysm

Question 21

what are the main signs for raised ICP?

-2

Answer 21

Papilloedema

↓GCS

Question 22

asides from the triad what are two main symptoms?

Answer 22

Headaches

Vomiting

Question 23

last resort surgery for ↑ICP?

Answer 23

Decompressive craniectomy

Question 24

procedure for hydrocephalus?

Answer 24

Extraventricular drains

Question 25

main drug for raised ↑ICP?

Answer 25

Mannitol

Question 26

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

Answer 26

Raise head

Question 27

primary IX? | -2

Answer 27

CT | ECG

Question 28

what is coning? what are two other names for this problem?

Answer 28

cerebellum moves down foramen magnus, brainstem compressed. Tonsillar Herniation Chiari syndrome

Question 29

which type of haematoma causes a thunderclap headache?

Answer 29

Subarachnoid

Question 30

which type of haematoma occurs from meningeal arteries bursting?

Answer 30

Epidural

Question 31

which type of haematoma occurs from meningeal bridging veins tearing?

Answer 31

Subdural

Question 32

which hematoma has a lemon shape?

Answer 32

Epidural

Question 33

which hematoma has a banana shape?

Answer 33

Subdural

Question 34

what are the two usual causes for subarachnoid haemorrhage?

Answer 34

rupture cerebral aneurysm trauma

Question 35

which haematoma has slow onset of symptoms? which blood vessels are damaged in said haematoma. arteries, vein or capillaries?

Answer 35

Subdural veins

Question 36

how long is a chronic subdural? hyow does this look on CT?

Answer 36

1 week blood gets darker on CT over time

Question 37

pt has a lucid period before their symptoms. what haematoma is this? why does this lucid pain happen?

Answer 37

Epidural Lucid period is brain compensating pressure

Question 38

what are the two commonly used surgery options for treating epidural? difference between them? which has a longer recovery?

Answer 38

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

Question 39

what is usual cause for a subarachnoid haemorrhage?

Answer 39

trauma

Question 40

in subarachnoid haemorrhages (SAH), cause has two categories, what are they? most common cause for each category?

Answer 40

traumatic SAH - trauma spontaneous SAH - burst berry aneurysm

Question 41

risk factors for a subarachnoid haemorrhage? | - 6

Answer 41

``` o Age o HTN o Smoking o FHx o Polycystic kidney disease o Alcohol excess ```

Question 42

Aneurysm at P comm A presses on what nerve? how will this manifest?

Answer 42

3rd nerve 3rd nerve palsy, down and out

Question 43

where is most common location for a burst berry aneurysm?

Answer 43

o Junction between anterior communicating artery and | anterior cerebral artery

Question 44

what are the causes for a spontaneous SAH? | -5

Answer 44

* Burst berry aneurysm * AV malformation * Mycotic aneurysm * Vertebra artery dissection * Tumour

Question 45

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?

Answer 45

xanthochromia haemoglobin breakdown to bilirubin 12 hours

Question 46

where does blood collect in the subarachnoid space?

Answer 46

Basal cisterns

Question 47

acute drug for SAH?

Answer 47

Nimodipine

Question 48

Nimodipine moa? how will this help in SAH?

Answer 48

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

Question 49

SAH can cause what to ICP?

Answer 49

raised, hydrocephalus

Question 50

why can SAH raise ICP?

Answer 50

blood leaks into ventricles

Question 51

ultimate treatment for SAH?

Answer 51

surgery - put coil in aneurysm

Question 52

drug you give for raised ICP?

Answer 52

mannitol