intracranial pressure

intracranial pressure is a medical condition encountered in clinical setting resulting from traumatic injury of brain, RTA, ischemia, stroke & similar brain pathology. understanding of this condition is necessary for prompt identification & management at early stage.

1. INCREASED INTRACRANIAL PRESSURE GEETA JOSHI SMIH, DEHRADUN

2. STRUCTURES IN CRANIUM BRAIN- 1400 gm BLOOD- 75 ml CSF- 75 ml

3. CEREBROSPINAL FLUID TOTAL VOLUME- 140- 270 ml RATE OF PRODUCTION- 0.2- O.7 ml/min or About 500- 700 ml/DAY INTRACARANIAL PRESSURE- 5-15 mmHg = CSF PRESSURE WHEN LYING DOWN.

4. CAUSES OF INCREASED ICP INCREASED BRAIN VOLUME SPACE OCCUPYING LESIONS TUMORS ABSCESS HEMATOMA CEREBRAL EDEMA ENCEPHALITIS

5. CAUSES OF INCREASED ICP INCREASED BLOOD VOLUME VASCULAR MALFORMATIONS CEREBRAL VENOUS THROMBOSIS MENINGITIS /ENCEPHALITIS HYPOXEMIA HYPERPYREXIA

6. CAUSES OF INCREASED ICP INCREASED CSF VOLUME HYDROCEPHALUS CHOROID PLEXUS PAPILLOMA OBSTRUCTION

7. PATHOPHYSIOLOGY OF INCREASED ICP

8. INCREASED INTRACRANIAL PRESSURE DECREASED CEREBRAL BLOOD FLOW ISCHEMIA & CELL DEATH STIMULATION OF VASOMOTOR CENTERS CUSHING’S RESPONSE HYPERTENSION BRADYCARDIA BRADYPNEA

9. MANIFESTATIONS OF INCREASING ICP S. NO INCREASING ICP MANIFESTATIONS 1 COGNITION (SENSITIVE TO HYPOXIA) DISORIENTATION, RESTLESSNESS, CONFUSION 2 CRANIAL NERVES (MIDBRAIN & BRAINSTEM) II, III, IV, VI (OPTIC, OCCULOMOTOR, TROCHLEAR, ABDUCENS) 3 PYRAMIDAL TRACTS WEAKNESS IN ONE EXTREMITY OR ONE SIDE OF THE BODY 4 PRESSURE ON VENOUS & ARTERIAL VESSELS HEADACHE AGGRAVATED BY MOVEMENT OR STRAINING

10. MONITORING ICP

11. MANAGEMENT OF INCREASED ICP REDUCE CEREBRAL EDEMA REDUCE CEREBRAL BLOOD VOLUM E REDUCE CSF VOLUME

12. REDUCE CEREBRAL EDEMA Osmotic diuretics Fluid restriction corticosteroids

13. REDUCE CSF VOLUME DRAINING CSF

14. REDUCE CEREBRAL BLOOD VOLUME CONTROLLING FEVER MAINTAINING BP OXYGENATION REDUCING CELLULAR METABOLIC DEMANDS

15. MAINITAINING CEREBRAL PERFUSION INOTROPIC AGENTS: DOBUTAMINE & NOREPINEPHRINE IMPROVEMENTS IN CARDIAC OUTPUT MAINTAIN CEREBRAL PERFUSION PRESSURE > 70 mmHg