Raised intracranial pressure

Question 1

Define Raised intracranial pressure

Answer 1

Volume inside cranium is fixed, so any increase in content leads to ICP.. Should be under 15mmHg

Question 2

Aetiology and risk factors of Raised intracranial pressure

Answer 2

tons of causes: mainly increase volume inside cranium
Primary/metastatic tumours
Head trauma
Hemmorghage (subdural, extradural, SAH)
Infections
Hydrocephalus, Cerebral oedema, Status epilepticus

risk factors; not relevant

Question 3

Signs and symptoms Raised intracranial pressure

Answer 3

Headache-worse of coughing/straining, leaning forward
Vomiting
Altered GCS (drowsy, etc)
Failing pulse and res BP (cushigns response)
Pupil changes: Constrict first then dilate
Lower visual acuity
Pappilloedema-unreliable

then disease specific
hx of trauma, LOC, etc
Fever, neck pain, rash
Neurosigns

Cushing reflex- tachycardia, Hypotension (or increasing BP range) and irregular breathing

mainly relevant to acute TBI

Question 4

Investigations for Raised intracranial pressure

Answer 4

mainly relevant to acute TBI
CT head-helps identify it and can give you clues (haemorrhage, trauma, hydrocephalus)

Cushing reflex- tachycardia, Hypotension (or increasing BP range) and irregular breathing

Bloods-markers of infections, clotting disorders, Epilepsy

Consider toxicology screen

Assess if LP safe and useful- (REMEMBER LP CAN BE VERY DANGEROUS iN ICP)

ART line, ICP monitor-over 20

Question 5

Mx of raised ICP

Answer 5

mainly relevant to acute TBI
See other cards for idiopathic cranial HTN

Post TBI-
immediate A-E with C spine support-and HEAD UP
Maintain mild Hypercapnia
Aim Cerebral Perfusion (CPP) between 60-70 (its MAP-Central venous Pressure or ICP (depends highest))

maintain via - osmotic therapy (mannitol), BP management, CSF drains n other

if non works-babituates to buy time–into–> Neurosurgery for Craniectomy/craniotomy