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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 tumours.
  • Can affect all age groups.
  • Incidence varies with underlying cause.

Aetiology and Pathophysiology

  • Traumatic brain injury.
  • Brain tumour.
  • Cerebral oedema.
  • Hydrocephalus.
  • Intracranial haemorrhage.
  • 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

  • Papilloedema.
  • Cushing’s triad (hypertension,Β 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 tumour).

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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