Rasised intracranial pressure

Question 1

Raised intracranial pressure can be a medical emergency. Is this always acute in presentation?

Answer 1

• no

Acute =head trauma
Chronic = tumour

Question 2

What is the normal pressure inside skull for adults?

1 -1-2 mmHg
2 - 3-7 mmHg
3 - 7-15 mmHg
4 - 20-30 mmHg

Answer 2

3 - 7-15 mmHg

Anything above this is classed as increased intracranial pressure

Question 3

Which of the following contribute to the intracranial pressure (ICP)?

1 - CSF
2 - blood
3 - brain
4 - all of the above

Answer 3

4 - all of the above

If one of these 3 increases, there must be a compensatory reduction in the others to maintain normal ICP of 7-15 mmHg

Question 4

There are a myriad of causes of raised intracranial pressure (ICP). Which of the following patients is most likely to experience idiopathic intracranial hypertension, a cause of raised ICP?

1 - pregnant obese female
2 - weight training male aged 35
3 - pregnant women with normal BMI
4 - patient aged >65

Answer 4

1 - pregnant obese female

Question 5

Which of the following is NOT a common cause of raised intracranial pressure (ICP)?

1 - idiopathic intracranial hypertension
2 - traumatic head injuries
3 - hypotension
4 - infection
5 - meningitis
6 - tumours
7 - hydrocephalus

Answer 5

3 - hypotension

Question 6

Raised intracranial pressure (ICP) can present with a variety of symptoms, but which 2 of the following are considered indicative of raised ICP?

1 - papilledema
2 - headache
3 - vomiting
4 - reduced levels of consciousness
5 - cushings triad
6 - seizures
7 - slow pupil reflexes

Answer 6

1 - papilledema
3 - vomiting

Question 7

Raised intracranial pressure (ICP) can present with a variety of symptoms, including cushings triad. Which of the following is not part of the Cushing triad?

1 - widened pulse pressure (increasing systolic, decreasing diastolic)
2 - papilledema
3 - bradycardia
4 - irregular respirations

Answer 7

2 - papilledema

Cushings triad is a late sign

Question 8

In patients with suspected raised intracranial pressure (ICP), what is the first line test?

1 - lumbar puncture
2 - head CT/MRI
3 - blood microbiology
4 - invasive invasive ICP monitoring

Answer 8

2 - head CT/MRI

Helps identify cause, before more invasive tests.

Question 9

Although normal intracranial pressure is 7-15 mmHg, what is the cut off used to determine if patients need treatment?

1 - >15 mmHg
2 - >20 mmHg
3 - >30 mmHg
4 - >45 mmHg

Answer 9

2 - >20 mmHg

Question 10

What is the most effective way of measuring intracranial pressure?

1 - estimate from BP
2 - invasive catheter placed into lateral ventricles
3 - estimate from optic disc
4 - lumbar puncture

Answer 10

2 - invasive catheter placed into lateral ventricles

Lumbar puncture can be used to reduce ICP, but not long term suitable

Question 11

Which 2 of the following can be effective at reducing intracranial pressure?

1 - head elevation
2 - leg elevation
3 - controlled hyperventilation
4 - cardiovascular exercise

Answer 11

1 - head elevation
3 - controlled hyperventilation

Question 12

How can 3 controlled hyperventilation reduce intracranial pressure (ICP)?

1 - increases CO2 levels
2 - increases O2 levels
3 - reduces O2 levels
4 - reduces CO2 levels

Answer 12

4 - reduces CO2 levels

• CO2 acts as a vasodilator
• lower CO2 vasoconstricts cerebral arteries and reduces ICP
• rapid reduction in ICP but only temporary, need to fix cause

Question 13

Which of the following medications can be used to lower intracranial pressure?

1 - Memantine
2 - Mannitol
3 - Furosemide
4 - Bendroflumethiazide

Answer 13

2 - Mannitol

Supposably works as an osmotic diuretic