Raised Intracranial Pressure

Question 1

Raised ICP

What causes raised intracranial pressure?

6

Answer 1

• neoplasms
• abscess
• hydrocephalus
• haematoma
• oedema
• idiopathic

Question 2

Raised ICP

Combination of what 3 symptoms/signs generally indicated raised ICP?

Answer 2

• headache
• papilloedma
• vomitting

Question 3

Raised ICP

Raised intracranial pressure symptoms:

Answer 3

• headache
• changes in mental state
• vomitting
• pupillary changes
• abnormal fundoscopy
• facial palsies
• late: motor changes/hypertension/wide pulse pressure
• syncope
• seizure / focal decifit

Question 4

Raised ICP

How might a headache be described?

Answer 4

• nocturnal
• starting when waking
• worse on coughing or moving head
• associated with altered mental state

Question 5

Raised ICP

What kind of mental state changes might we see?

Answer 5

• lethargy
• irritability
• slow decision making
• abnormal social behaviour

Question 6

Raised ICP

What kind of pupillary changes might we see?

Answer 6

irregularity or dilatation in one eye.

Question 7

Raised ICP

What might we see on fundoscopy?

Answer 7

• blurring of the disc margins
• loss of venous pulsations
• disc hyperaemia
• flame-shaped haemorrhages

- In later stages, obscured disc margins and retinal haemorrhages may be seen.

Question 8

Raised ICP

What kind of facial palsies might we see?

Answer 8

Unilateral ptosis or 3rd and 6th nerve palsies

Question 9

Raised ICP

What investigations should be carried out?

Answer 9

• **CT/MRI **scanning to determine any underlying lesion.
• Check and monitor blood glucose, renal function, electrolytes and osmolality.

Question 10

Raised ICP

When might we use intracranial monitoring?

Answer 10

• Used either as a guide to treatment or as a diagnostic test.
• The most common use of continuous ICP monitoring is in the management of severe closed head injury.

Question 11

Raised ICP

What conditions can cause raised ICP?

Answer 11

• haemorrhage
• infection
• idiopathic
• cancer
• hydrocephalus
• reye’s syndrome

Question 12

Raised ICP

What are some first-line therapies?

Answer 12

• avoid pyrexia
• Manage seizures
• CSF drainage
• Head of bed elevation
• Analgesia and sedation
• Neuromuscular blockade
• Mannitol
• Hyperventilation

Question 13

Raised ICP

What is mannitol and what is it used for?

Answer 13

a diuretic that is used to reduce swelling and pressure inside the eye or around the brain

Question 14

Raised ICP

Question 15

Raised ICP

Question 16

Raised ICP

Question 17

Raised ICP

Question 18

Raised ICP

Question 19

Raised ICP

Question 20

Raised ICP