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A - MSRA Neuro and Stroke [12] > [22] Raised ICP > Flashcards

[22] Raised ICP Flashcards

(40 cards)

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1
Q

What is raised ICP?

A

When the pressure inside the skull (and thus the brain and CSF) is increased

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2
Q

What is a normal ICP at rest in a supine adult?

A

7-15mmHg

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3
Q

Is raised ICP acute or chronic?

A

Can be either

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4
Q

What are the ways in which the body can regulate the ICP?

A
  • Changes in CSF production and absorption
  • Autoregulation
  • Chemoregulation
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5
Q

What happens in autoregulation (re: ICP)?

A

Vasoconstriction and vasodilation can occur in response to changes in blood pressure

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6
Q

What happens in chemoregulation (re: ICP)?

A

There is vasodilation in response to low cerebral pH

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7
Q

What are changes in ICP attributed to?

A

Changes in the volume of one or more of the constituents within the cranium

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8
Q

What can change in volume within the cranium to lead to raised ICP?

A
  • Blood
  • CSF
  • Brain (and other tissue)
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9
Q

What are the common causes of raised ICP?

A
  • Localised mass lesions
  • Neoplasms
  • Abscess
  • Focal oedema
  • Disturbance of CSF circulation
  • Obstruction to major venous sinuses
  • Diffuse brain oedema and swelling
  • Idiopathic intracranial hypertension
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10
Q

What is an example of a localised mass lesion that can lead to raised ICP?

A

Traumatic haematoma

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11
Q

Give examples of neoplasms that can cause raised ICP?

A
  • Glioma
  • Meningioma
  • Metastases
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12
Q

What can lead to focal oedema causing raised ICP?

A
  • Trauma
  • Infarction
  • Tumour
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13
Q

What are the types of CSF disturbance?

A
  • Obstructive hydrocephalus

- Communicating hydrocephalus

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14
Q

What happens in obstructive hydrocephalus?

A

There is blockage to the circulation of the CSF causing back pressure to build up

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15
Q

What happens in communicating hydrocephalus?

A

There is impaired absorption of the CSF but no obstruction to flow

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16
Q

What can cause obstruction to major venous sinuses?

A
  • Depressed fractures overlying the venous sinuses

- Cerebral venous thrombosis

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17
Q

What can lead to diffuse brain oedema and swelling?

Study These Flashcards
A
  • Encephalitis
  • Meningitis
  • Diffuse head injury
  • Subarachnoid haemorrhage
  • Reye’s syndrome
  • Lead encephalopathy
  • Water intoxication
  • Near drowning
18
Q

What are the typical presenting signs and symptoms of raised ICP?

Study These Flashcards
A
  • Headache
  • Papilloedema
  • Vomiting
  • Changes in mental state
19
Q

Describe a typical headache seen in raised ICP?

Study These Flashcards
A
  • Nocturnal or starts on waking

- Worse on coughing or moving head

20
Q

What can also be seen on fundoscopy as well as papilloedema?

Study These Flashcards
A
  • Blurred disc margins
  • Loss of venous pulsations
  • Disc hyperaemia
  • Flame-shaped haemorrhage
21
Q

How does vomiting present in early raised ICP?

22
Q

What can happen to vomiting later in raised ICP?

Study These Flashcards
A

Progress to projectile

23
Q

What changes to mental state can occur in raised ICP?

Study These Flashcards
A
  • Lethargy
  • Irritability
  • Slow decision making
  • Abnormal social behaviour
24
Q

What are the late signs of raised ICP?

Study These Flashcards
A
  • Motor changes (hemiparesis)
  • Raised BP
  • Widened pulse pressure
  • Slow irregular pulse
25
What investigations may be useful in assessing raised ICP?
- CT/MRI scan - Blood glucose - Renal function - U&E's - ICP monitoring
26
Why can CT/MRI be useful in assessing raised ICP?
To look for an underlying lesion
27
What can ICP monitoring be useful for?
Diagnosing and guiding treatment
28
When is ICP monitoring most commonly used?
Management of a severe closed head injury
29
When is ICP monitoring appropriate? | This is a bad card no way around it sorry
- Severe head injury and abnormal CT scan - Severe head injury and normal CT scan if two of; over 40, motor psoturing, systolic BP <90mmHg - Subarachnoid haemorrhage with hydrocephalus - Reye;s syndrome - Brain tumour - Idiopathic intracranial hypertension
30
What are the differentials for raised ICP?
Other causes of headache
31
What are some other causes of headache?
- Tension headache - Migraine - Cluster headache
32
What are some possible first line therapies for raised ICP?
- Avoiding pyrexia - Managing seizures - CSF drainage - Head of bed elevation - Analgesia and sedation - Mannitol - Hyperventilation
33
How should seizures be managed in raised ICP?
Aggresively with standard anticonvulsant loading regimens
34
How are patients with raised ICP usually sedated?
IV propfol, etomidate or midazolam
35
How are patients with raised ICP given pain relief?
Morphine or alfentanil
36
What is mannitol?
An intravascular osmotic agent
37
What problems are associated with mannitol use?
Hypovolaemia and hyperosmotic state
38
What second line therapies may be used to treat raised ICP?
- Barbiturate coma - Optimised hyperventilation - Hypothermia - Decompressive craniotomy
39
Who with raised ICP are high dose barbiturates harmful to?
Those with head injuries
40
What are the potential complications of raised ICP?
- Seizures - Stroke - Neurological damage - Death

A - MSRA Neuro and Stroke [12] (33 decks)

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