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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