(f1) evaluation of a patient with increased intracranial pressure

8/13/2019 (f1) Evaluation of a Patient With Increased Intracranial Pressure

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EVALUATION OF A PATIENT WITH INCREASED

INTRACRANIAL PRESSURE

Understanding its Signs and Dreadful Effects

Dra Di!ina " Hernande#$ FPNA

Se%te&'er ($ )*+(

*if you will not treat the cause of IICP/ manage IICP, it can lead to

coma.

T,e Anat-&ic As%ects -f ICP

Cerebrospinal Fluid

review of the CSF flow

CSF production: produced by the choroid pleus in the lateral !rd

and "th #entricles $%&& ml/day'

CSF #olume in the #entricular space: (! ml) "+ ml is reabsorbed.CSF also bathes the lumbar and subarachnoid space

nidirectional

If there is a bloc-ade in the subarachnoid space IICP $firstintra#entricular pressure then intracranial pressure'

S-ull and the ertebral column

For as long as the sutures are fused $children:known skull sutures

will fuse by2 y/o; 25 y/o: all thebasilar sutures will close' nomore gi#ing way 0

If there is something happening in the brain before the sutures close,there will be an enlarging head circumference and the sutures willnot close, therefore there is widening of sutures. 1he fontanels which

may still be open, will be bulging. Children with compensation in the

s-ull will not ha#e signs and symptoms of IICP

Cerebral blood flow

20% of cardiac outut or !50 "l/ "in2 1he brain recei#es constant

blood supply re#ardless of what is happening in the body. $1he brainis 3selfish3.' In cases of hyovole"ia or hyo$e"ia, the brain stilldraws blood until compensation fails: loss of consciousness.

*4thers:

5ura mater

#ery durable) does not yield to increased #olume

if there is traction, you may eperience headache

a closed #ault, where the meningeal layer continues into thespine

1entorium: separates the corte from the infratentorial structures$cerebellum and the brainstem'

1entorial notch: opening) #ery important in relation to herniation

Fal Cerebri : does not completely di#ide the cerebral hemispheres

anteriorly

Tent-riu& Cere'elli

li-e a 3tent3

increase in pressure supratentorially or

infratentorially tentorium will constrict or press onthe brain stem

*Cli#us: posterior to it:basilar artery) where the pons sits

T,e Tent-riu& and t,e Ven-us Sinuses

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*5o not forget the #eins6 1he #enous sinuses which lie inbetween the dural reflections are the main draining structuresof the brain. 1he blood must be drained goes to the heart

for recirculation.

#eins can cause IICP and possible instantaneous

death $unli-e arterial, which ta-es time'

if compressed IICP

Relati-ns,i% -f t,e tent-riu& /it, t,e 'rainste&

E%idural ,e&at-&a

*there is a tearing of the meningeal artery raidly growinghematoma

Its shape is dependent on the sutures $remember: 7lns li-e8lntiform shape pidural 0'

Patient with epidural hematoma: lucid intervals$cycle of sleepingand wa-ing, where the patient is awa-e shorter and shorter andasleep longer and longer) can happen few hours after the in9ury'

e#entually will lead to co"a

T,e T,ree Intracranial C-&%-nents

1. Brain

1350g (femae!" # 1500g (mae!"

($: Its not the weight of the brain that counts:p'

*only around %&g when suspended in CSF

2. CSF %o&me

'5#10 mL a) an* one )ime

function: buoyancy effects for protection and support

3.Boo+ %o&me , '5# 150 mL

Cere'ral 0l--d fl-/

20- of C./ or '50 mLmin goe! )o )e rain

cere'ral aut-1regulati-n

*capacity to regulate and maintain a constant cerebralblood supply/flow.

*Stro-e: degenerati#e process: atherosclerosis rigidblood #essels constriction

aii)* )o main)ain erera 4erf&!ion i)in !)ri)*+e)ermine+ imi)! om4en!a)or* ange in C78 inre!4on!e )o %aria)ion! in %a!&ar 4re!!&re!

e#en with low systemic blood pressure, the brain will still

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get +%& m;/min $the brain is a 3spoiled brat3'

only with prolonged hypotension will the patient loseconsciousness coma death

CBF 9 CAP # :7PC78

ere CAP 9 aro)i+ ar)er* 4re!!&re

:7P 9 ;&g&ar %eno&! 4re!!&re

C78 9 erero#%a!&ar re!i!)ane (m*ogeni/a&)onomi an+ me)aoi meani!m!"


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Res%irat-r4 C,anges in Increased ICP

due to in9uries to the pons and medulla

ischemia due to blood #essel or artery compression $uncus

may compresses the artery'

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0edside "anage&ent -f Increased ICP

ee%a)e )e ea+ 30

ea+ m&!) aa*! e in ne&)ra 4o!i)ion

en!&re 4a)en) aira*

BP moni)oring an+ managemen) # rememer )a) HTN i! aa)e manife!)a)ion Do no) ao )e 4a)ien) )o !)rainA+%i!e )e 4a)ien) no) )o ea) g&a%a/ anana/ e)

+o no) ao 4a)ien) )o !)rain

orre) fe%er

Su&&ar4:Te rigid s7ullan+ &n*ie+ing dura &aterare )e mainanatomical

structuresen +eaing i) inrea!e+ ICP

In infan)! an+ *o&ng i+ren/ en )e anteri-r f-ntaneli! !)io4en/ inrea!e+ ICP i! no) rea+i* a44aren)

*cats cry: #ery shrill H sign of IICP

*fontanel: if you feel pulsations: o-6 0

Aut if it is rigid: $fatal angeeeel na'

=en )e in)rarania %o&me e?ee+! )e c-&%ensat-r4&ec,anis&sof )e in)rarania om4onen)!/ !ign! an+ !*m4)om! ofinrea!e+ ICP are manife!)e+

(f1) evaluation of a patient with increased intracranial pressure

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