Raised Intracranial Pressure Flashcards

1
Q
A
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2
Q

What is the intracranial and spinal vault enclosed by?

A

Dura mater and bone

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3
Q

What does the intracranial and spinal vault contain?

A
  • Neural tissue (brain and spinal cord)
  • Blood
  • CSF
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4
Q

What is intracranial pressure?

A

The pressure within the intracranial space

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5
Q

What is the normal ICP?

A

5-15mmHg

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6
Q

What occupies the intracranial space?

A
  • CSF
  • Blood
  • Brain
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7
Q

How is blood flow to the brain regulated in an healthy individual?

A
  • Autoregulation
  • Chemoregulation
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8
Q

How does autoregulation of blood flow to the brain occur?

A
  • Vasoconstriction
  • Vasodilation
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9
Q

How does chemoregulation of blood flow to the brain occur?

A

Vasodilation in response to a low cerebral pH

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10
Q

What is the result of adaptation of the brain, blood, and CSF?

A

It can maintain ICP to a degree, even in disease states

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11
Q

Describe the steps in the pathophysiology of a brain injury?

A
  1. Reduction in blood supply to brain cells, e.g. compression by intracranial tumour
  2. Cytotoxic cellular oedema
  3. Further swelling and compression, so further reduction in blood supply to brain cells
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12
Q

What are the signs and symptoms of raised ICP?

A
  • Headache
  • Vomiting
  • Visual disturbances
  • Depression of conscious level
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13
Q

What are the features of the headache caused by raised ICP?

A
  • Generalised ache
  • Worst on awakening in the morning
  • May awaken patient from sleep
  • Severity gradually progresses
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14
Q

Why is the headache from raised ICP worse in the morning?

A

As a result of hypoventilation during the sleeping hours

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15
Q

What factors aggregate the headache caused by raised ICP?

A
  • Bending or snooping
  • Coughing or sneezing
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16
Q

Describe the vomiting caused by raised ICP

A

Nausea and vomiting that progresses to projective vomiting

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17
Q

What visual disturbances might occur with raised ICP?

A
  • Blurring
  • Obscurations
  • Papilloedema
  • Retinal haemorrhages
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18
Q

What are obscurations?

A

Transient blindness upon bending or posture changes

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19
Q

When will raised ICP patients get retinal haemorrhages?

A

If the rise in ICP has been rapid

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20
Q

How might slowly increasing intracranial pressure present in infants?

A

As slowly increasing head size

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21
Q

What happens if raised ICP is not treated, and continues to rise?

A

You get herniation through the foramen magnum

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22
Q

What is the clinical relavance of herniation through the foramen magnum?

A

It is a poor prognostic sign

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23
Q

What is Cushing’s reflex?

A

A last effort to perfuse the brain, whereby there is;

  • Increased blood pressure
  • Irregular breathing
  • Bradycardia
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24
Q

What causes the bradycardia in Cushing’s reflex?

A

Ischaemia at the medulla leads to sympathetic activation, which causes a rise in blood pressure and tachycardia. Baroreceptors react, causing bradycardia

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25
Q

What causes the low respiratory rate in the Cushing’s reflex?

A

Ischaemia at the respiratory centres in the pons/medulla

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26
Q

What are the categories of causes of raised intracranial pressure?

A
  • Increased cerebral blood volume
  • Cerebral oedema
  • Increased CSF
  • Space occupying lesion
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27
Q

What can cause an increased cerebral blood volume?

A
  • Venous outflow obstruction
  • Venous sinus thrombosis
28
Q

What can cause increased CSF?

A
  • Impaired absorption
  • Excessive secretion
29
Q

What can cause impaired absorption of CSF?

A
  • Hydrocephalus
  • Benign intracranial hypertension
30
Q

What can cause excessive secretion of CSF?

A

Choroid plexus papilloma

31
Q

What can cause cerebral oedema?

A
  • Meningitis
  • Encephalitis
  • Diffuse head injury
  • Infarction
32
Q

What space occupying lesions can cause raised ICP?

A
  • Abscess
  • Tumour
  • Haemorrhage/haemotoma
33
Q

What is the most common cause of raised ICP?

A

Traumatic brain injury

34
Q

What needs to be thought about in suspected raised ICP due to traumatic brain injury?

A
  • Epidural, subdural, and subarachnoid harmorrhages
  • Use of anticoagulants
35
Q

What might suggest severe meningitis encephalitis as the cause of raised ICP?

A
  • Signs/symptoms of meningitis
  • Immunosupression
  • Tb exposure
36
Q

What can severe meningitis encephalitis cause in the short term?

A

Brain oedema

37
Q

What can severe meningitis encephalitis cause in the long term?

A

Venous outflow obstruction

38
Q

What colour is normal CSF?

A

Clear and colourless

39
Q

Describe the composition of normal CSF

A
  • Very little protein - 15 to 45mg/dL
  • Little immunoglobulin
  • 1-5 cells per ml
40
Q

How are changes to CSF clinically important?

A

They are useful in diagnosis of a variety of disease processes

41
Q

What is accumulation of CSF thought to be due to?

A

Imbalance between production and absorption of CSF with subsequent enlargement of brain ventricles

42
Q

How common in hydrocephalus?

A

1 in 1000 births

43
Q

What are the classifications of hydrocephalus?

A
  • Non-communicating/obstructive
  • Communicating
44
Q

What is non-communicating/obstructive hydrocephalus?

A

CSF is obstructed within the ventricles, or between the ventricles and subarachnoid space

45
Q

What is non-communicating/obstructive hydrocephalus most commonly due to?

A

Aqueduct blockage

46
Q

Is non-communicating/obstructive hydrocephalus congential or acquired? her

A

Can be either

47
Q

Give an example of an acquired cause of hydrocephalus

A

Tumours, e.g. meningiomas

48
Q

What is communicating hydrocephalus?

A

When there is communication between the ventricles, or between the ventricles and subarachnoid space, and so the problem lies outside of the venticular system

49
Q

What problems with CSF might cause communicating hydrocephalus?

A
  • Reduced absorption or blockage of the venous drainage system
  • Increased CSF production
50
Q

What conditions might cause communicating hydrocephalus?

A
  • Post-meningitis, ​bacterial, fungal, or TB
  • Subarachnoid haemorrhage
  • Trauma
  • Neoplastic infiltration of subarachnoid space
  • Choroid plexus papilloma
51
Q

What is the incidence of brain tumours?

A

1 in 10,000

52
Q

Where are the age peaks for brain tumours?

A
  • Children
  • Late middle age
53
Q

How does the incidence of brain tumours in children differ to other childhood cancers?

A

Second most common childhood cancer after leukaemia

54
Q

What are the most common forms of paediatric brain tumours?

A
  • Astrocytomas from astrocytes
  • Medulloblastomas from neuroectoderm cells
55
Q

Where in the brain to brain tumours tend to effect?

A

Midline or posterior region

56
Q

What are the most common types of brain tumours in adults?

A
  • Gliomas
  • Meningiomas
  • Metastases from lung, breast, and kidney
57
Q

What is idiopathic intracranial hypertension?

A

Raised intracranial pressure without evidence of hydrocephalus or mass lesion

58
Q

What will be round on investigation with idiopathic intracranial hypertension?

A
  • Normal investigations, including imaging of the brain
  • Signs of raised ICP
59
Q

Who is idiopathic intracranial hypertension most commonly found in?

A

Obese young women

60
Q

What are the treatment options for idiopathic intracranial hypertension?

A
  • Weight loss
  • Medical management using drugs
  • CSF drainage and shunts
61
Q

Give an example of a drug that can be used to treat idiopathic intracranial hypertension

A

Carbonic anhydrase inhibitors

62
Q

How is ICP caused by increased cerebral blood volume treated?

A
  • Anticoagulation
  • Rarely, tenting of venous sinuses
63
Q

How is raised ICP caused by cerebral oedema treated?

A
  • Treat the cause
  • Mannitol
  • Hypertonic saline
64
Q

How is raised ICP caused by increased CSF treated?

A
  • Shunts
  • Tumour resection
  • Diuretics whilst awaiting intervention, e.g. furosemide, carbonic anhydrase inhibitors
65
Q

How is raised ICP caused by space occupying lesions treated?

A
  • Surgical resection, e.g. craniotomy
  • Steroids of high value for brain tumours