Increased Intracranial Pressure

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Increased Intracranial Pressure
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• Normal ICP 10 to 20 mm Hg
• Monro Kellie hypothesis
• Causes of increased ICP -
• head injury
• brain tumours,
• subarachnoid haemorrhage, and
• toxic and viral encephalopathies.

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Brain Herniation

• Increased ICP
• decreases cerebral perfusion,
• stimulates further swelling (oedema)
• shifts brain tissue through openings in the
  rigid dura, resulting in herniation a serious
  problem

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• Cushings response
• ? ICP ? decreased perfusion of brain tissue ?
  vasomotor centre increases systolic pressure of
  blood in an effort to increase the perfusion
  heart rate decreases immediate intervention is
  needed
• At a particular level the ability to autoregulate
  the perfusion is lost leading to significant
  changes in mental status and vital signs.
• Cushings triad The bradycardia, hypertension
  and bradypnoea asssociated with the deterioration

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Clinical Manifestations

• Reacts only to loud auditory or painful stimuli
• Stupor
• Coma
• Abnormal motor responses in the form of
  decortication, decerebration ,flaccidity
• Pupils dilate, get fixed
• Respiration impaired
• Death

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A decorticate rigidity B decerebrate rigidity
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Assessment and diagnostic findings

• Cerebral angiography
• Computed tomography (CT) scanning
• Magnetic resonance imaging (MRI)
• Positron emission tomography
• Transcranial doppler studies
• Lumbar puncture avoided

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PAPILLOEDEMA
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Normal optic fundus
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Comparing the normal fundus and papolloedema
fundus
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• There are three main types of herniation.

• Herniating from one side of the falx cerebri to
  the other side below the falx cerebri
• 2, Through the opening in the tentorium cerebelli
  downward or upward
• 3 Through the foramen magnum downward

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Viewing from . below
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Nursing Care

• Maintain a patent airway
• Achieve an adequate breathing pattern
• Optimize cerebral tissue perfusion
• Maintain negative fluid balance

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Treatment

• Treat the underlying cause

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• Maintain a patent airway inserting airway,
  endotracheal tube, tracheostomy
• Achieve an adequate breathing pattern -
  ventilator
• Optimize cerebral tissue perfusion give O2
• Maintain negative fluid balance give lesser
  fluid than the urine and other output