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FINALS - NEURO > raised ICP + brain injury > Flashcards

raised ICP + brain injury Flashcards

1
Q

motor responses GCS

A

6 = obeys commands // 5 = localises pain // 4 = withdraws to pain // 3 = flex to pain // 2 = extend to pain // 1 = none

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2
Q

verbal response GCS

A

5 = orientated // 4 = confused // 3 = words // 2 = sounds // 1 = none

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3
Q

eye response GCS

A

4 = spontaneous // 3 = speech // 2 = pain // 1 = none

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4
Q

what is the munro-kelli hypothesis

A

increasing volume of brain, CSF, or blood must decrease volume of the others

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5
Q

what is the cerebral perfusion pressure

A

net pressure grafient causing blood flow to the brain

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6
Q

how is CPP calculated and what value should it ve

A

CCP = mean arterial pressure - intracranial pressure

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7
Q

what can raised CCP cause

A

raised ICP

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8
Q

what can low CCP cause

A

ischaemia

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9
Q

what should the ICP be

A

7-15 mmHg

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10
Q

what does raised CO2 cause

A

vasoldilation of cerebral vessels (raised ICP)

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11
Q

what can cause raised ICP

A

idiopathic hypertension // trauma // infection // tumour // hydrocephalus

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12
Q

symptoms raised ICP

A

headache, N+V, LOC, papilloedema, cushings triad

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13
Q

what is cushings triad of ICP

A

wide pulse pressure, hypertension, bradycardia, irregular HR

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14
Q

invx raised ICP

A

CT/MRI // invasie ICP monitoring

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15
Q

mx raised ICP

A

head elevation 30 // IV mannitol // hyperventilation (to cause cerebral vasocontriction)

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16
Q

how is oedema –>brain swelling preveneted

A

dexamtheasone

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17
Q

what causes brain herniation

A

raised ICP

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18
Q

what is subfalcine herniation

A

cingulate gyrus under falx cerebri (eg left hemisphere into right)

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19
Q

what is central herniation

A

downards displacement of brain

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20
Q

what is transtentorial herniation

A

displacement of uncus of temporal love under tentorium

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20
Q

what is transtentorial herniation

A

displacement of uncus of temporal love under tentorium

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21
Q

what is uncal herniation

A

type of transtentorial - causes unilateral blown and fixed pupil

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22
Q

what is tonsillar herniation

A

coning - BAD // cerebellar through foramun magnum

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23
Q

what is transcalvarial hernaition

A

brain herniated through bone defect eg fracture, craniotomy

24
Q

what is a coup contusion

A

contusion same side as brain injury

25
Q

what is a contre-coup contusion

A

contusion on other side of head injury

26
Q

what GCS is a come

A

8

27
Q

what is secondary brain injury

A

oedema, ischaemia, infection, herniation

28
Q

criteria for brain death (4)

A

deep coma of known origin // no reversible cause // no sedation // normal electrolytes

29
Q

testing brain death

A

fixed pupils // no corneal reflex // no oculo-vestibular reflex (inject ice water to ear) // no response to supraorbital pressure // no gag reflex // no breathing

30
Q

who can test brain death

A

2 doctors at least 5 years post-grad

31
Q

RF for idiopathic intracranial hypertension

A

fat, female, pregnant, drugs

32
Q

what meds can cause idiopathic intracranial hypertension

A

COCP, steroid, TETRACYCLINES eg doxy, retinoids, lithium

33
Q

symptoms idiopathic intracranial hypertension

A

headache, blurred vision, papilloedema, blind spot, colour desat

34
Q

lifestle mx idiopathic intracranial hypertension

A

lose weight

35
Q

medical mx idiopathic intracranial hypertension

A

diuretic eg acetazolamide // topreimate // LP // surgery

36
Q

where to intracranial VTs usually occur

A

50% sagittal sinus // 50% lateral + cavernous sinus

37
Q

symptoms intracranial VT

A

headache (sudden onset) // N+V // reduced consciousness

38
Q

invx intracranial VT

A

MRI venography!!! // d dimer

39
Q

mx intracranial VT

A

anticoag: acute = LMWH // longterm = warfarin

40
Q

symptoms sagital sinus VT

A

seizure + hemiplegia // empty delta on venography

41
Q

cavernous + sinus thrombosis symptoms

A

6+7 nerve palsy // central retinal occlusion // periorbital oedema

42
Q

what is an arnold-chiari maldormation

A

downward displacement of cerebellar tonsils through magnum foramun (no raised ICP as opposed to tonsillar herniation

43
Q

symptoms arnold-chiari maldormation

A

obstruction of CSF –>non-communication hydrocephalus // headache // syringomyelia

44
Q

what is hydrocephalus

A

build up CSF from either too much production or too little reabsorption

45
Q

symptoms hydrocephalus

A

headache, N+V, papilloedema, coma

46
Q

symptoms hydrocepphalus children

A

increase in head circumference as sutures not shut, anterior fontanelle bulge, upwards case

47
Q

what can cause obstructive (non-communicating) hydrocephalus

A

tumours, haemorrhage

48
Q

what causes non-obstructive (communicating) hydrocephalus

A

CSF imbalance eg increased production CSF (chroid tumour - rare) // decreased absorption eg meningitis

49
Q

what is normal pressure hydrocephalus

A

non-obstructive, large ventricles + normal ICP

50
Q

normal pressure hydrocephalus triad + imaging

A

dementia, incontinence, gait issues // CT = big ventricles with no sucal enlargement

51
Q

invx hydrocephalus

A

1st line = CT // best = MRI // LP = diagnostic + mx

52
Q

when should LP for hydrocephalus be avoided

A

obstructive –> brain herniation

53
Q

mx hydrocephalus

A

acute = external ventricular drain // chronic = VP shunt

54
Q

mx normal pressure hydrocephalus

A

VP shunt

55
Q

what is Reye’s syndrome

A

encephalopathy with fatty liver, kidney, pancreas

56
Q

symptoms and age Reye’s

A

2 yrs // encephalopathy: confusion, seizure, cerebral oedema // hypoglucaemia

57
Q

at what GSC should you intubate

A

<8

58
Q

quick test to determine if fluid is CSF

A

glucose

FINALS - NEURO (16 decks)

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