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Raised intracranial pressure

Background knowledge 🧠

Definition

  • Raised intracranial pressure (ICP) refers to increased pressure within the skull and thus on the brain tissue and cerebrospinal fluid (CSF)
  • Normal ICP is 7-15 mmHg in adults
  • ICP over 20 mmHg is typically considered pathological

Epidemiology

  • Common in traumatic brain injury
  • Occurs in stroke, hydrocephalus, and brain tumors
  • Can affect all age groups
  • Incidence varies with underlying cause

Aetiology and Pathophysiology

  • Brain tumor
  • Cerebral edema
  • Hydrocephalus
  • Intracranial hemorrhage
  • Traumatic brain injury
  • Increased CSF production or decreased absorption

Clinical Features 🌑️

Symptoms

  • Headache (worse in the morning)
  • Nausea and vomiting
  • Blurred vision
  • Altered mental status
  • Seizures
  • Focal neurological deficits

Signs

  • Papilledema
  • Cushing’s triad (hypertension, bradycardia, irregular respirations)
  • Cranial nerve palsies (especially CN VI)
  • Decreased level of consciousness

Investigations πŸ§ͺ

Tests

  • CT scan of the head
  • MRI of the brain
  • Lumbar puncture in some cases (if no risk of herniation)
  • ICP monitoring
  • Blood tests (e.g., full blood count, electrolytes)
  • EEG (if seizures suspected)

Management πŸ₯Ό

Management

  • Elevate head of bed to 30 degrees
  • Osmotic agents (e.g., mannitol, hypertonic saline)
  • Sedation and analgesia
  • CSF drainage via ventriculostomy
  • Surgical decompression (e.g., craniectomy)
  • Treat underlying cause (e.g., antibiotics for infection, surgery for tumor)

Complications

  • Brain herniation
  • Permanent neurological deficits
  • Seizures
  • Death

Prognosis

  • Depends on underlying cause and timeliness of treatment
  • Higher morbidity and mortality if untreated
  • Early intervention improves outcomes

Key Points

  • Early recognition and management are crucial
  • Multidisciplinary approach often required
  • Regular monitoring of ICP in high-risk patients

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