Raised intracranial pressure

Question 1

Define:

Answer 1

The volume inside the cranium is fixed and so any increase in the content lead to an increase in ICP

Can be mass effect, oedema or obstruction to outflow.

In a normal adult the ICP should be <15mmHg

Question 2

Aetiology/risk factors:

Answer 2

Causes:

• Primary malignancy or metastasis
• Haemorrhage
• Head injury
• Hydrocephalus
• Infection - meningitis, encephalitis or brain abscess
• Cerebral oedema
• Status Epilpeticus

Question 3

Epidemiology:

Answer 3

Depends on the cause

Question 4

Symptoms:

Answer 4

Headaches - worse on coughing, lying down and in the morning + on leaning forward.

Vomiting

Altered GCS - drowsiness, irritability and coma

Hx of trauma

Poor vision

Question 5

Signs:

Answer 5

Papilloedema

Altered GCS

Falling pulse and increase BP (cushing’s reflex)

Cheyne-Stokes respiration – progressively deeper and sometimes faster breathing followed by a gradual decrease that results in a temporary stop in breathing - cycle repeats

Pupil changes - constriction and then dilation

Reduced visual acuity

Peripheral visual field loss

Question 6

Investigations:

Answer 6

Bloods:
FBC
U+Es
LFTS
Glucose 
Serum Osmolality 
Clotting 
Blood cultures 

Tox Screen

CXR - to see if you can find the route of the infection

CT head

LP - if safe but rare as increase ICP and LP can lead to herniation