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08 Neuro > Increased ICP > Flashcards

Increased ICP Flashcards

1
Q

normal icp values

A

adults 4-15 mmhg
children 3-7 mmhg
infants 1.5-6 mmhg

increased >20 cmh2o / >15 mmhg

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2
Q

monro kellie doctrine

A

brain, csf, and blood are incompressible
change in volume -> damage to others
inc. brain vol -> dec. blood volume -> dec CSF

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3
Q

compliance vs elastance

A

compliance: quality of distensibility available within intracranial contents that enable them to adapt to lesions
elastance: resistance of contents to the expansion of mass

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4
Q

defect and presentation of subfalcine or cingulate herniation

A

defect: compression of internal cerebral vein and anterior cerebral artery
presentation: contralateral hemiparesis

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5
Q

defect and resentation of central transtentorial herniation

A

page 2 (4 items)

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6
Q

defect in uncal herniation

A

compression of midbrain, 3rd nerve, pca

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7
Q

defect and presentation of tonsillar herniation

A

page 3

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8
Q

normal cpp

A

60-80 mmhg

< 50 cerebral ischemia
< 30 brain death

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9
Q

cbf values

A

n: 50 ml/min/100g

10-15 ml/100g/min reversible ischemia
<10-15 irreversible ischemia

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10
Q

normal map

A

50-150 mmhg

> 150 increase cbf, constricted
<50 decreased cbf, dilated

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11
Q

normal hourly and daily rate of csf production

A

20 ml/hr

450-500 ml/day

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12
Q

triad in increased icp

A

headache*
vomiting
papilledema (most reliable sign, fundoscopy)

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13
Q

t/f papilledema does not affect visual acuity

A

true

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14
Q

vital signs in increased icp

A

triad: hpn, bradycardia, bradypnea

pain, agitation, blood loss -> paradoxic tachycardia

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15
Q

focal deficits in increased icp

A

decreased consciousness and mental status
cardiac dysrhtymias
pupillary abnormalities
bilateral rectus palsy

icp >40-50 mmhg -> dec blood flow -> global ischemiai -> dec consciousness

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16
Q

types of brain swelling

A

cytotoxic
vasogenic
hydrocephalic
hydrostatic

17
Q

what is cytotoxic edema

A

excess fluid in intracellular space
involves gray and white matter

responsive to osmolar therapy

18
Q

what is vasogenic edema

A

excess fluid in interstitial space
white matter edema (gray sparing)
disruption of bbb and diffusion of water

responsive to glucocorticoids

19
Q

what is hydrocephalic edema

A

transependymal seepage of csf into interstitium

intact bbb

20
Q

what is hydrostatic edema

A

malignant hypertension -> disrupt bbb –> transvascular diffusion into interstitial space

occurs in posterior circulation

21
Q

causes of inc venous pressure

A

sagittal sinus thrombosis
heart failure
obstruction of mediastinal or jugular veins
pseudotumor cerebri

22
Q

mechanisms of csf flow obstruction

A

ventricles or base of brain = hydrocephalus

extensive meningeal disease (meningitis, subarachnoid hemorrhage, leptomeningeal carcinomatosis)

23
Q

t/f if the csf block is at the cerebral convexities and SSS, ventricles remain in size or slightly enlarge only

A

true

24
Q

causes of csf expansion

A

meningitis, subarachnoid hemorrhage, choroid plexus tumor

25
Q

hypertonic solutions for management

A 
mannitol = osmotic dehydration and diuretic effect
hypertonic saline
hypertonic lactate
furosemide
glycerol
26
Q

use of steroids for management

A

effective for vasogenic edema but not cytotoxic edema

27
Q

principle of head elevation

A

30 deg = dec intrathoracic pressure and inc jugular vein drainage = dec icp by 3-4 mmhg

dec in icp = dec cpp –> ISCHEMIA

28
Q

principle of hyperventilation

A

rapidly reduces icp by reflex vasoconstriction due to hypocapnic csf alkalosis

reduces icp in 10 min, peak effect at 20-40 mins

29
Q

target paco2 in hyperventilation

A

35 mmhg
patients in icp crisis or herniation = 28-32 mmhg

NOT <28 mmhg

30
Q

use of sedation in management

A

pain = narcotics
agitation = short acting sedatives
coughing at et tube = sedatives
shivering = narcotics

31
Q

principle of metabolic suppression

A

suppresses brain metabolism by hypothermia and general anes –> reduced blood flow

pentobarbital or propofol

32
Q

there is mortality benefit in duraplasty for patients ___ age with malignant mca if surgery is done within ___ hrs

A

<60 yo

within 24-48h

33
Q

indications for icp monitoring

A 
gcs <8 and abnormal ct OR
normal ct with (2/3):
- >40 yo
- unilateral or bilateral posturing 
-systolic bp < 90
34
Q

gold standard for icp monitoring

A

extra ventricular drain

  • icp monitor
  • intermittent drainage

08 Neuro (24 decks)

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