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ESA 5 - Nervous System > Raised Intracranial Pressure > Flashcards

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
What causes the low respiratory rate in the Cushing's reflex?
Ischaemia at the respiratory centres in the pons/medulla
26
What are the categories of causes of raised intracranial pressure?
* Increased cerebral blood volume * Cerebral oedema * Increased CSF * Space occupying lesion
27
What can cause an increased cerebral blood volume?
* Venous outflow obstruction * Venous sinus thrombosis
28
What can cause increased CSF?
* Impaired absorption * Excessive secretion
29
What can cause impaired absorption of CSF?
* Hydrocephalus * Benign intracranial hypertension
30
What can cause excessive secretion of CSF?
Choroid plexus papilloma
31
What can cause cerebral oedema?
* Meningitis * Encephalitis * Diffuse head injury * Infarction
32
What space occupying lesions can cause raised ICP?
* Abscess * Tumour * Haemorrhage/haemotoma
33
What is the most common cause of raised ICP?
Traumatic brain injury
34
What needs to be thought about in suspected raised ICP due to traumatic brain injury?
* Epidural, subdural, and subarachnoid harmorrhages * Use of anticoagulants
35
What might suggest severe meningitis encephalitis as the cause of raised ICP?
* Signs/symptoms of meningitis * Immunosupression * Tb exposure
36
What can severe meningitis encephalitis cause in the short term?
Brain oedema
37
What can severe meningitis encephalitis cause in the long term?
Venous outflow obstruction
38
What colour is normal CSF?
Clear and colourless
39
Describe the composition of normal CSF
* Very little protein - 15 to 45mg/dL * Little immunoglobulin * 1-5 cells per ml
40
How are changes to CSF clinically important?
They are useful in diagnosis of a variety of disease processes
41
What is accumulation of CSF thought to be due to?
Imbalance between production and absorption of CSF with subsequent enlargement of brain ventricles
42
How common in hydrocephalus?
1 in 1000 births
43
What are the classifications of hydrocephalus?
* Non-communicating/obstructive * Communicating
44
What is non-communicating/obstructive hydrocephalus?
CSF is obstructed within the ventricles, or between the ventricles and subarachnoid space
45
What is non-communicating/obstructive hydrocephalus most commonly due to?
Aqueduct blockage
46
Is non-communicating/obstructive hydrocephalus congential or acquired? her
Can be either
47
Give an example of an acquired cause of hydrocephalus
Tumours, *e.g. meningiomas*
48
What is communicating hydrocephalus?
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
What problems with CSF might cause communicating hydrocephalus?
* Reduced absorption or blockage of the venous drainage system * Increased CSF production
50
What conditions might cause communicating hydrocephalus?
* Post-meningitis, *​bacterial, fungal, or TB* * Subarachnoid haemorrhage * Trauma * Neoplastic infiltration of subarachnoid space * Choroid plexus papilloma
51
What is the incidence of brain tumours?
1 in 10,000
52
Where are the age peaks for brain tumours?
* Children * Late middle age
53
How does the incidence of brain tumours in children differ to other childhood cancers?
Second most common childhood cancer after leukaemia
54
What are the most common forms of paediatric brain tumours?
* Astrocytomas from astrocytes * Medulloblastomas from neuroectoderm cells
55
Where in the brain to brain tumours tend to effect?
Midline or posterior region
56
What are the most common types of brain tumours in adults?
* Gliomas * Meningiomas * *Metastases from lung, breast, and kidney*
57
What is idiopathic intracranial hypertension?
Raised intracranial pressure without evidence of hydrocephalus or mass lesion
58
What will be round on investigation with idiopathic intracranial hypertension?
* Normal investigations, including imaging of the brain * Signs of raised ICP
59
Who is idiopathic intracranial hypertension most commonly found in?
Obese young women
60
What are the treatment options for idiopathic intracranial hypertension?
* Weight loss * Medical management using drugs * CSF drainage and shunts
61
Give an example of a drug that can be used to treat idiopathic intracranial hypertension
Carbonic anhydrase inhibitors
62
How is ICP caused by increased cerebral blood volume treated?
* Anticoagulation * *Rarely,* tenting of venous sinuses
63
How is raised ICP caused by cerebral oedema treated?
* *Treat the cause* * Mannitol * Hypertonic saline
64
How is raised ICP caused by increased CSF treated?
* Shunts * Tumour resection * Diuretics whilst awaiting intervention, *e.g. furosemide, carbonic anhydrase inhibitors*
65
How is raised ICP caused by space occupying lesions treated?
* Surgical resection, *e.g. craniotomy* * Steroids of high value for brain tumours

ESA 5 - Nervous System (18 decks)

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