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Questions and Answers
What is the normal range of ICP measured in the lateral ventricles?
Which of the following is NOT a management strategy for increased ICP?
What is the earliest sign of increasing ICP?
Which of the following is a component of neurologic examination?
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What is the term for the state of awareness and responsiveness to the environment and the senses?
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What is the term for a condition characterized by a reduced sense of touch or sensation?
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What is the primary goal of maintaining a patent airway in the management of increased ICP?
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What is the term for a condition characterized by unequal pupils?
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What is the primary mechanism of action of osmotic diuretics in reducing cerebral edema?
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What is the recommended range for PaCO2 in the management of increased ICP?
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Study Notes
Increased Intracranial Pressure (ICP)
- Normal ICP is 10 to 20 mm Hg, measured in the lateral ventricles.
- The rigid cranial vault contains brain tissue, blood, and cerebrospinal fluid (CSF), which are in equilibrium, producing the ICP.
Pathophysiology of Increased ICP
- Elevated ICP is associated with head injury, brain tumors, and hemorrhage.
- Increased ICP decreases cerebral perfusion, stimulates further swelling (edema), and shifts brain tissue, resulting in herniation (a frequently fatal event).
Management of Increased ICP
- Monitoring ICP, decreasing cerebral edema, maintaining cerebral perfusion, reducing CSF and intracranial blood volume, controlling fever, maintaining oxygenation, and reducing metabolic demands are key to managing increased ICP.
- Decreasing cerebral edema can be achieved through osmotic diuretics (mannitol), corticosteroids, avoiding overhydration, and monitoring fluid and electrolyte balance.
- Reducing CSF and intracranial blood volume can be achieved through CSF drainage, maintaining the PaCO2 at 30 to 35 mm Hg, and hyperventilation (in patients whose ICP is unresponsive to conventional therapies).
- Maintaining oxygenation involves systemic oxygenation, maintaining a patent airway, and suctioning with care.
Clinical Manifestations of Increased ICP
- Restlessness, confusion, increasing drowsiness, changes in level of consciousness (LOC), abnormal respiratory and vasomotor responses, motor or sensory disturbances, stupor, coma, and pupillary changes are all clinical manifestations of increased ICP.
- The earliest sign of increasing ICP is a change in LOC, with slowing of speech and delay in response to verbal suggestions as other early indicators.
Neurologic Examination
- Evaluation of mental status, LOC, motor and sensory function, pupil checks, and vital signs are all part of a neurologic examination.
- The Glasgow Coma Scale may be used to evaluate LOC.
Pupillary Examination
- Midriasis is an enlarged pupil, while miosis is a constricted pupil.
- Ä°socoria is equality of pupils, while anisocoria is inequality of pupils.
Motor and Sensory Changes
- Paresis is a condition characterized by weakness of voluntary movement, while plegia is paralysis in which all voluntary movement is lost.
- Hypoesthesia refers to a reduced sense of touch or sensation, while paresthesia is an abnormal sensation such as tingling, numbness, or burning of skin.
- Abnormal motor responses can also occur.
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Description
Learn about the pathophysiology of increased intracranial pressure (ICP), its causes, and normal ICP values. Understand how head injuries, brain tumors, and hemorrhages affect ICP.
