Raised Intracranial Pressure Flashcards
1
Q
AETIOLOGY
Main causes
A
- Brain tumours
- Intracranial haemorrhage
- Idiopathic intracranial hypertension
- Abscesses or infection
2
Q
CLINICAL FEATURES
Presentation
A
- Concerning features of headache
- Alterned mental state
- Visual field defects
- Seizures (particularly focal)
- Unilateral ptosis
- Third and sixth nerve palsies
- Papilloedema (on fundoscopy)
3
Q
What is papilloedema
A
Swelling of optic disk secondary to raised intracranial pressure
4
Q
Fundoscopic changes of papilloedema
A
- Blurring of disc margins
- Elevated disc (look at way retinal vessels flow across disc - curved)
- Loss of venous pulsation
- Engorged retinal veins
- Haemorrhoges around optic disc
- Patons lines (creases in retina around optic disc)
5
Q
AETIOLOGY
Pathophysiology
A
- Consequences of elevated ICP
- Decreased cerebral perfusion pressure (CPP)
- Brain tissue herniation
6
Q
3 cerebral herniation syndromes
A
- Subfalcine herniation
- Uncal herniation
- Foramen magnum herniation
7
Q
Presentation subfalcine herniation
A
- Cingulate gyrus of one hemisphere compressed and herniates under falx cerebri causing
- Compressing of contralateral hemisphere - obstruction of foramen of Monro - hydrocephalus
- Compression pericallosal arteries - hemiparesis (mostly lower limbs)
8
Q
Presentation uncal herniation
A
- Medial temporal lobe (uncus) herniates at tentorial incisure, compression of
- Ipsilateral oculomotor nerve - fixed and dilated pupil
- Ipsilateral posterior cerebral artery - cortical blindness with contralatereal homonymous hemianopia
- Contralateral cerebral peduncle - ipsilateral paralysis
- Downward shift brainstem - focal deficits, impaired consciousness, death
9
Q
Presentation foramen magnus herniation
A
- Structures of posterior fossa (eg cerebellar tonsils, medulla) herniates at foramen magnum
- Impaired consciousness, decerebrate posturing, apnea, impaired circulation, death
10
Q
INVESTIGATIONS
First choice
A
- Neuroimaging (CT head/MRI head)
- Maybe invasive ICP monitoring
- Intraventricular catheter
- Intraparnchymal catheter
11
Q
MANAGEMENT
General principles
A
- Acute resuscitation and stabilisation - ABCDE
- Early involvement of neurosurgery
- Conservative, medical and surgical options
12
Q
MANAGEMENT
Conservative
A
- Patient positioning (bed elevated about 30)
- Sedation and analgesia - combindations of benzodiazepines, opiods and dexmedatomidiline used
- Fluid management
- Seizure control - antiepileptics
13
Q
MANAGEMENT
Medical
A
- Hyperosmolar therapy
- IV mannitol
- Glucocorticosteroids if secondary to CNA infection or neoplasms
14
Q
MANAGEMENT
Surgical options
A
- Emergency surgery (eg resection brain tumour)
- CSF drainage
- Decompressive craniectomy (removal part of skull)
15
Q
COMPLICATIONS
A
- Brain death (irreversible loss of brain function)
- Cerebral oedema
