Sketchy Path: Neuro - "Intracranial Hypertension" Flashcards
Intracranial hypertension is defined as pressure with the skull greater than _______.
20 mm Hg (like the ropes on the balloon that spell out > XX)
Give the formula for cerebral perfusion pressure (CPP).
CPP = MAP –ICP
Which etiology of ICH is represented by the blue helmet?
Hydrocephalus (notice the ventricle pattern on the sides)
What electrolyte abnormality can cause cerebral edema?
Hyponatremia (like the peanuts falling out of the balloon that represents the interstitium)
Explain the pathophysiology behind hypoxia-induced cerebral edema.
Hypoxia limits the production of ATP. Low ATP levels lead to decreased activity of the Na/K pump. Decreased Na/K activity lead to increased intracellular Na which pulls water into cells.
Hypoxia-induced CE leads to what finding on imaging?
Loss of gray-white differentiation (like the guys dressed in gray and white pulled close to each other)
Brain cancer causes what kind of CE?
Vasogenic (like the crab attached to the balloon with red ropes with water)
Cancer causes angiogenesis, and the new vessels are leaky.
Other than cancer, what two things also cause vasogenic edema?
- Meningitis (guy with red turban)
* Trauma (woodpecker)
Review the signs and symptoms of cerebral edema.
- Seizure (guy getting electrocuted)
- AMS, from mild confusion to coma (guy passed out over side of balloon basket)
- Vomiting (balloon with green ooze from mouth)
- Papilledema (swollen bottom of balloon)
- Diplopia due to abducens palsy (guy with crossed eyes)
Effacement of __________ can be seen on cranial imaging of someone with ICH.
sulci (like the smushed brain on the basket)
Extreme ICH can lead to what triad of symptoms?
Cushing’s triad:
- Bradycardia (falling watch)
- HTN (guy blowing off steam trying to lift fallen passenger)
- Irregular respirations (guy holding his breath trying to lift fallen passenger)
The most serious complication of brain herniation is ____________.
compression of arteries leading to strokes; for instance, a subfalcine herniation can occlude the ACA and a transtentorial herniation can occlude the basilar artery
Uncal herniation leads to ______________ of the eye.
ipsilateral abduction and inferior movement (“down and out”) with mydriasis
Extreme uncal herniation can lead to ____________ of the contralateral eye.
homonymous hemianopsia (blacked out contralateral field of view) due to occlusion of PCA and ischemia to occipital lobe
What sensorimotor symptoms can uncal herniation cause?
Ipsilateral hemiparesis and numbness due to occlusion of contralateral cerebral peduncle
(Think of the lowest pirate on the left side of the herniation balloon with the dangling left leg –he’s lowest because that is how low the herniation needs to get.)
