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Year 3 > Raised intracranial pressure (N) > Flashcards

Raised intracranial pressure (N) Flashcards

1
Q

What is raised intracranial pressure, and how does it come about?

A
  • increased pressure in the cranium
  • as the brain and ventricles are enclosed by a rigid skull, they have a limited ability to accommodate additional volume
  • additional volume –> rise in ICP
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2
Q

What is normal ICP in adults in the supine position?

A

</=15mmHg

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3
Q

What are some causes of raised intracranial pressure? (6)

A
  • idiopathic intracranial hypertension
  • CNS infection - meningitis, encephalitis, brain abscess
  • space occupying lesions - haemorrhage, aneurysm, tumours
  • increased CSF i.e. hydrocephalus
  • cerebral oedema
  • increased BP (malignant hypertension)
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4
Q

What is idiopathic intracranial hypertension?

A

AKA pseudotumour cerebri, a disorder of increased ICP of unknown cause

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5
Q

What demographic does idiopathic intracranial hypertension classically happen in?

A

Young, overweight females

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6
Q

What are the clinical features of idiopathic intracranial hypertension? (4)

A
  • headache
  • blurred vision
  • papilloedema on fundoscopy
  • CN VI palsy
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7
Q

What does CT show in idiopathic intracranial hypertension?

A

Enlarged arachnoid outpouchings and prominent perivascular spaces

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8
Q

What drug can increase the risk of developing idiopathic intracranial hypertension?

A

Tetracyclines e.g. doxycycline

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9
Q

How do we manage idiopathic intracranial hypertension? (2)

A
  • weight loss (low-sodium weight-reduction diet)
  • acetazolamide (carbonic anhydrase inhibitor)
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10
Q

What are some examples of CNS infections that can cause raised ICP?

A

Meningitis, encephalitis, brain abscess

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11
Q

What are some examples of space-occupying lesions (raised ICP)? (3)

A
  • haemorrhage
  • aneurysm
  • tumours
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12
Q

What is it called when a patient has increased CSF (raised ICP)?

A

Hydrocephalus

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13
Q

What are the clinical features of raised ICP? (4)

A
  • bilateral headache
  • vomiting
  • reduced level of consciousness
  • bilateral visual field loss (raised ICP may compress optic nerve)
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14
Q

What is seen on examination in raised ICP? (5)

A
  • Cushing Triad - reflects brainstem compression (irregular breathing, widening PP, bradycardia)
  • fundoscopy - papilloedema (swelling of optic disc)
  • altered GCS
  • Cheyne-Stokes respiration - progressively deeper and sometimes faster breathing followed by gradual decrease that results in temporary stop in breathing + cycle repeats
  • CN palsies - III, IV, VI, RAPD
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15
Q

When is the bilateral headache in raised ICP worse? (2)

A
  • in morning and lying down due to gravity
  • when coughing/straining - if patient presents with headache upon straining, non-contrast CT head must be done
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16
Q

Why is there bilateral visual loss in raised ICP?

A

Raised ICP may compress optic nerve

17
Q

What is the Cushing Triad (raised ICP)?

A

Reflects brainstem compression

  • irregular breathing
  • widened pulse pressure (hypertension)
  • bradycardia
18
Q

What does papilloedema look like on fundoscopy (raised ICP)?

A

Blurring of optic disc margin

19
Q

What is Cheyne-Stokes respiration (raised ICP)?

A

Progressively deeper and sometimes faster breathing followed by gradual decrease that results in temporary stop in breathing + cycle repeats

20
Q

What are some clinical features that are more specific to idiopathic intracranial hypertension (raised ICP)? (3)

A
  • pulse-synchronous tinnitus (unilateral)
  • photophobia
  • retrobulbar pain
21
Q

How does obstructive hydrocephalus present (raised ICP)?

A

Acute drop in conscious level, diplopia

22
Q

How does normal pressure hydrocephalus present (raised ICP)? (3)

A

Triad of:

  • dementia/cognitive impairment
  • gait disturbances (apraxia/shuffling)
  • urinary incontinence
23
Q

What is a risk factor for idiopathic intracranial hypertension (raised ICP)?

A

Tetracyclines e.g. doxycycline

24
Q

What are the first-line investigations for idiopathic intracranial hypertension (raised ICP)? (4)

A
  • dilated fundoscopy
  • visual field testing (perimetry)
  • visual acuity
  • MRI of brain +/- contrast
25
Q

What investigation can help us understand the underlying cause of raised ICP?

A

Neuroimaging - CT/MRI head

26
Q

What other main investigation is there for raised ICP, apart from CT/MRI?

A

Invasive ICP monitoring - intraventricular catheter –> monitoring device placed into ventricles of brain along with CSF drainage system

Useful in conditions where CSF drainage is required for both diagnostic and therapeutic purposes e.g. hydrocephalus

27
Q

What ICP level on invasive ICP monitoring would indicate treatment is needed?

A

> 20mmHg

28
Q

What do we measure in lumbar puncture (L3/4) in raised ICP?

A

Measure opening pressure (definite: >250mmHg, intermediate: 200-250mmHg)

29
Q

What are some differential diagnoses for raised ICP?

A

THIN BB

  • Trauma
  • Hydrocephalus / haemorrhage
  • Infection
  • Neoplasm
  • Bleeding
  • Benign intracranial hypertension
30
Q

What is the diagnostic criteria for idiopathic intracranial hypertension? (5)

A
  • Sx of raised ICP
  • absence of localised findings on neurological examination
  • absence of deformity, displacement, or obstruction of the ventricular system
  • patient alert and awake
  • no other causes
31
Q

How do we manage idiopathic intracranial hypertension? (2)

A
  • weight loss if obese: low-sodium weight-reduction diet
  • acetazolamide (carbonic anhydrase inhibitor)
  • (discontinue tetracyclines, retinoids and excessive vitamin A)
32
Q

What is a simple 1st step to management of raised ICP?

A

Head elevation to 30 degrees

33
Q

What drug can be given to reduce ICP?

A

IV mannitol (osmotic diuretic) - hyperosmolar solution that helps drain water out of brain, reducing ICP

(Used in patients with raised ICP secondary to traumatic brain injury)

34
Q

What can we do if the underlying cause of raised ICP is hydrocephalus (excess CSF)?

A

CSF drainage (via external ventricular drain)

35
Q

What must be done before CSF drainage (if required) in raised ICP?

A

IV mannitol must be given first

36
Q

What can we give for raised ICP due to CNS infection or inflammation (or cancer)?

A

Glucocorticoid - dexamethasone

37
Q

What breathing strategies can help reduce ICP?

A

Controlled hyperventilation –> reduced pCO2 –> vasoconstriction of cerebral arteries –> reduced ICP

38
Q

When might emergency surgery be required for raised ICP? (2)

A
  • presence of tumour –> resection
  • haematoma –> evacuation
39
Q

What are some complications of raised ICP? (4)

A
  • cerebral oedema
  • decreased cerebral perfusion pressure
  • brain tissue herniation
  • severe irreversible visual loss

Year 3 (192 decks)

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