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Neurology

Raised Intracranial Pressure

Coma

Headache

Dangers of Raised Intracranial Pressure

Herniation

Herniations: Brain Shifts

Tentorial

Foramen Magnum

Falx

Herniation

As brain compliance decreases.

Infarction and death are unpredictable outcomes of herniation, and they may occur in seconds.

Mannitol 1 g/kg IV is safe, and it should be given immediately when increased intracranial pressure is suspected.

Symptoms of Raised ICP in Children

Headache

Vomiting

Lethargy or irritability

Abducens palsy, strabismus, and diplopia

Papilledema

Symptoms in Infants

Bulging fontanelle

Distended scalp veins

"Sunsetting" of eyes

Rapid growth of head circumference

Irritability, lethargy, and poor feeding

Critically Raised ICP: Consciousness

Confusion

Stupor

Coma neurology, raised intracranial pressure, coma, headache, elevated intracranial pressure

Critically Raised ICP: Respirations

Sighs: Cheyne-Stokes

Central Neurogenic Hyperventilation

Gasping; respiratory arrest

Critically Raised ICP: Pupils

Small, reactive pupils

3-5 mm, fixed

Critically Raised ICP: Extraocular Movements

Roving, uninhibited extraocular movements

Incomplete, dysconjugate gaze

Absent extraocular movements

Critically Raised ICP: Motor Response

Spastic, decorticate posturing

Decerebrate posturing

Flaccid

Critically Raised ICP: Uncal Herniation

Ipsilateral Pupillary Dilatation

Contralateral Hemiparesis

Raised ICP with Focal Lesion on CT

Hydrocephalus

Infarction

Mass Lesion

Hemorrhage

Tumor

Abscess Cyst

Inflammatory mass

Raised ICP with Diffuse Swelling on CT

Hypoxic-Ischemic Injury

Trauma

Infection: Meningitis, encephalitis

Hypertension

Metabolic derangement or toxin exposure