Lec 22: Herniation and Increased ICP

Question 1

Intracranial hypertension is defined as a CSF pressure of?

Answer 1

> 15mmHg

Question 2

Intracranial pressure associated with 100% mortality

Answer 2

60mmHg

Question 3

Generalized Causes of Increased ICP Except
A. Expanding mass 
B. Increase in water content
C. Skull Fracture
D. Increase in CSF
E. Excessive Secretion
F. Increase in Cerebral Blood Volume

Answer 3

C

Question 4

narrowest part of the CSF pathway that is blocked in hydrocephalus

Answer 4

Aqueduct of Sylvius

Question 5

shearing of axons in the white matter tracts

Answer 5

Diffuse axonal injury

Question 6

mos common cause of SAH

Answer 6

trauma

Question 7

Acute extradural or chronic subdural hematoma? biconvex in shape

Answer 7

Acute extradural hematoma

Question 8

Acute extradural or chronic subdural hematoma? concave, appears dark

Answer 8

chronic subdural hematoma

Question 9

What type of hydrocephalus? Obstruction to CSF flow in the subarachnoid space after exit from the fourth ventricle

Answer 9

Communicating hydrocephalus

Question 10

What type of hydrocephalus? Obstruction to CSF flow at outlet foramina

Answer 10

Non-Communicating Hydrocephalus

Question 11

Formula for Cerebral Perfusion Pressure (CPP)

Answer 11

MAP – ICP = CPP

Question 12

What type of cerebral edema? First one to occur in stroke

Answer 12

Cytotoxic cerebral edema

Question 13

What type of cerebral edema? Second one to occur in stroke

Answer 13

Vasogenic cerebral edema

Question 14

What type of cerebral edema? due to the increased permeability of the endothelium of capillaries

Answer 14

Vasogenic cerebral edema

Question 15

What type of cerebral edema? Associated with swollen cells, glia or neurons due to accumulation of intracellular water and sodium

Answer 15

Cytotoxic cerebral edema

Question 16

What type of cerebral edema? Water in the ventricular system is already full so ependymal cells are pushed and water seeps out in between the ependymal cells

Answer 16

interstitial edema

Question 17

Normal CPP value

Answer 17

50-100mmHg

Question 18

Formula for Cerebral Blood Flow (CBF)

Answer 18

Cerebral Perfusion Pressure (CPP) / Cerebral Vascular Resistance (CVR)

Question 19

T/F. Always assume patient is in a High Compliance Level/Region

Answer 19

F. Always assume patient is in a Low Compliance Level/Region

Question 20

Factors that interfere with autoregulation EXCEPT
A. Hypoxia ( PaO2 < 80)
B. Hypocapnia ( PCO2 < 35)
C. Hypotension ( MAP < 90)
D. Hypovolemia

Answer 20

B. Hypoxia ( PaO2 < 80), Hypercapnia ( PCO2 > 35), Hypotension ( MAP < 90), Hypovolemia

Question 21

most potent vasodilator affecting the brain

Answer 21

CO2

Question 22

Clinical Signs of Central Hernation

Answer 22

1. Changes in Sensorium
2. Pupillary and Eye changes
3. Respiratory Changes
4. Abnormal Motor Posturing

Question 23

Cardinal Signs and Symptoms of Raised ICP

Answer 23

1. Headache
2. Vomiting (controlled from the area postrema)
3. Papilledema
4. Drowsiness progressing to coma and death

Question 24

Cushing’s Triad

Answer 24

1. Hypertension
2. Bradycardia
3. Bradypnea
   (Hyper Bra’s)

Question 25

Results when uncal herniation forces midbrain to shift so that the contralateral cerebral peduncle is forced against contralateral tentorial incisura

Answer 25

Kernohan’s Notch Syndrome

Question 26

What type of herniation? ipsilateral third-nerve paresis

Answer 26

Uncal herniation