raised ICP + brain injury

Question 1

motor responses GCS

Answer 1

6 = obeys commands // 5 = localises pain // 4 = withdraws to pain // 3 = flex to pain // 2 = extend to pain // 1 = none

Question 2

verbal response GCS

Answer 2

5 = orientated // 4 = confused // 3 = words // 2 = sounds // 1 = none

Question 3

eye response GCS

Answer 3

4 = spontaneous // 3 = speech // 2 = pain // 1 = none

Question 4

what is the munro-kelli hypothesis

Answer 4

increasing volume of brain, CSF, or blood must decrease volume of the others

Question 5

what is the cerebral perfusion pressure

Answer 5

net pressure grafient causing blood flow to the brain

Question 6

how is CPP calculated and what value should it ve

Answer 6

CCP = mean arterial pressure - intracranial pressure

Question 7

what can raised CCP cause

Answer 7

raised ICP

Question 8

what can low CCP cause

Answer 8

ischaemia

Question 9

what should the ICP be

Answer 9

7-15 mmHg

Question 10

what does raised CO2 cause

Answer 10

vasoldilation of cerebral vessels (raised ICP)

Question 11

what can cause raised ICP

Answer 11

idiopathic hypertension // trauma // infection // tumour // hydrocephalus

Question 12

symptoms raised ICP

Answer 12

headache, N+V, LOC, papilloedema, cushings triad

Question 13

what is cushings triad of ICP

Answer 13

wide pulse pressure, hypertension, bradycardia, irregular HR

Question 14

invx raised ICP

Answer 14

CT/MRI // invasie ICP monitoring

Question 15

mx raised ICP

Answer 15

head elevation 30 // IV mannitol // hyperventilation (to cause cerebral vasocontriction)

Question 16

how is oedema –>brain swelling preveneted

Answer 16

dexamtheasone

Question 17

what causes brain herniation

Answer 17

raised ICP

Question 18

what is subfalcine herniation

Answer 18

cingulate gyrus under falx cerebri (eg left hemisphere into right)

Question 19

what is central herniation

Answer 19

downards displacement of brain

Question 20

what is transtentorial herniation

Answer 20

displacement of uncus of temporal love under tentorium

Question 20

what is transtentorial herniation

Answer 20

displacement of uncus of temporal love under tentorium

Question 21

what is uncal herniation

Answer 21

type of transtentorial - causes unilateral blown and fixed pupil

Question 22

what is tonsillar herniation

Answer 22

coning - BAD // cerebellar through foramun magnum

Question 23

what is transcalvarial hernaition

Answer 23

brain herniated through bone defect eg fracture, craniotomy

Question 24

what is a coup contusion

Answer 24

contusion same side as brain injury

Question 25

what is a contre-coup contusion

Answer 25

contusion on other side of head injury

Question 26

what GCS is a come

Answer 26

8

Question 27

what is secondary brain injury

Answer 27

oedema, ischaemia, infection, herniation

Question 28

criteria for brain death (4)

Answer 28

deep coma of known origin // no reversible cause // no sedation // normal electrolytes

Question 29

testing brain death

Answer 29

fixed pupils // no corneal reflex // no oculo-vestibular reflex (inject ice water to ear) // no response to supraorbital pressure // no gag reflex // no breathing

Question 30

who can test brain death

Answer 30

2 doctors at least 5 years post-grad

Question 31

RF for idiopathic intracranial hypertension

Answer 31

fat, female, pregnant, drugs

Question 32

what meds can cause idiopathic intracranial hypertension

Answer 32

COCP, steroid, TETRACYCLINES eg doxy, retinoids, lithium

Question 33

symptoms idiopathic intracranial hypertension

Answer 33

headache, blurred vision, papilloedema, blind spot, colour desat

Question 34

lifestle mx idiopathic intracranial hypertension

Answer 34

lose weight

Question 35

medical mx idiopathic intracranial hypertension

Answer 35

diuretic eg acetazolamide // topreimate // LP // surgery

Question 36

where to intracranial VTs usually occur

Answer 36

50% sagittal sinus // 50% lateral + cavernous sinus

Question 37

symptoms intracranial VT

Answer 37

headache (sudden onset) // N+V // reduced consciousness

Question 38

invx intracranial VT

Answer 38

MRI venography!!! // d dimer

Question 39

mx intracranial VT

Answer 39

anticoag: acute = LMWH // longterm = warfarin

Question 40

symptoms sagital sinus VT

Answer 40

seizure + hemiplegia // empty delta on venography

Question 41

cavernous + sinus thrombosis symptoms

Answer 41

6+7 nerve palsy // central retinal occlusion // periorbital oedema

Question 42

what is an arnold-chiari maldormation

Answer 42

downward displacement of cerebellar tonsils through magnum foramun (no raised ICP as opposed to tonsillar herniation

Question 43

symptoms arnold-chiari maldormation

Answer 43

obstruction of CSF -->non-communication hydrocephalus // headache // syringomyelia

Question 44

what is hydrocephalus

Answer 44

build up CSF from either too much production or too little reabsorption

Question 45

symptoms hydrocephalus

Answer 45

headache, N+V, papilloedema, coma

Question 46

symptoms hydrocepphalus children

Answer 46

increase in head circumference as sutures not shut, anterior fontanelle bulge, upwards case

Question 47

what can cause obstructive (non-communicating) hydrocephalus

Answer 47

tumours, haemorrhage

Question 48

what causes non-obstructive (communicating) hydrocephalus

Answer 48

CSF imbalance eg increased production CSF (chroid tumour - rare) // decreased absorption eg meningitis

Question 49

what is normal pressure hydrocephalus

Answer 49

non-obstructive, large ventricles + normal ICP

Question 50

normal pressure hydrocephalus triad + imaging

Answer 50

dementia, incontinence, gait issues // CT = big ventricles with no sucal enlargement

Question 51

invx hydrocephalus

Answer 51

1st line = CT // best = MRI // LP = diagnostic + mx

Question 52

when should LP for hydrocephalus be avoided

Answer 52

obstructive --> brain herniation

Question 53

mx hydrocephalus

Answer 53

acute = external ventricular drain // chronic = VP shunt

Question 54

mx normal pressure hydrocephalus

Answer 54

VP shunt

Question 55

what is Reye's syndrome

Answer 55

encephalopathy with fatty liver, kidney, pancreas

Question 56

symptoms and age Reye's

Answer 56

2 yrs // encephalopathy: confusion, seizure, cerebral oedema // hypoglucaemia

Question 57

at what GSC should you intubate

Answer 57

<8

Question 58

quick test to determine if fluid is CSF

Answer 58

glucose