Multiple Choice Questions on Intracranial Pressure Monitoring

Causes of Raised ICP (Increased Intracranial Pressure)

A raised ICP can be due to various reasons

  • Brain abscess
  • Brain tumor
  • Hemorrhage
  • Hematoma
  • Meningitis
  • Encephalitis
  • Hepatic encephalopathy
  • Uremia
  • Lead or arsenic intoxication
  • Obstruction of venous outflow .Eg. lateral flexion of neck
  • Hyperemia
  • Hypercapnia

Raised ICP (Increased Intracranial Pressure)

Neurological and neurosurgical unit of any hospital is a very busy unit. Unlike patents with other disease conditions, a person suffering from a neurological conditionand admitted to the hospital will be mostly dependent.

They also require continuous monitoring of their vital signs and other bodily functions. The most important and common problem which most of these patients have is increased intracranial pressure.

You can test your knowledge related to raised ICP here.....

Headache and vomiting are considered as the earliest symptoms of raised ICP. The patient explains the headache as very severe and something which she/he had never experienced before. Sometimes the head ache starts at night; the patient wakens with headache and it increases in severity with coughing or turning the head.

Brain Herniation-a lethal side effect of Raised ICP

Source

Normal ICP is the pressure exerted by the following three components

  • Blood, Brain, Bone

  • CSF, Blood, Brain

  • CSF, Blood, Bone

  • CSF, Brain, Bone

    ------------------------------------

    Answer: CSF, Blood, Brain

Normal ICP (in mm of Hg) ranges from

  • 0- 15

  • 3- 18

  • 6- 21

  • 9- 24

    -------------------------------

    Answer: 0 -15

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A rise in Intracranial Pressure will compromise

  • Cerebral Perfusion Pressure

  • Mean Arterial Pressure

  • Systolic Pressure

  • Diastolic Pressure

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Answer: Cerebral Perfusion Pressure

A Colloid Cyst in the Third Ventricle inside the Brain-A condition which can lead to Raised ICP

Source

Cerebral Perfusion Pressure

cerebral Perfusion Pressure has to be maintained within narrow limits as too little of it can cause ischemia to the brain and too much of it can cause increased intracranial pressure.

This is why managing the fluid balance in a patient with increased intracranial pressure becomes tricky.

Great attention to be given to the intake and output maintenance of such patients.

Cerebral Perfusion Pressure is equal to

Mean Arterial Pressure – Intra Cranial Pressure

Mean Arterial Pressure + Intra Cranial Pressure

Mean Arterial Pressure X Intra Cranial Pressure

Mean Arterial Pressure / Intra Cranial Pressure

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Answer: Mean Arterial Pressure – Intra Cranial Pressure

Normal Cerebral Perfusion Pressure (in mm of Hg) is in the range of

  • 50 - 80

  • 70 - 100

  • 90 – 120

  • 110 – 140

-------------------------------

Answer: 70 - 100

MRI (T1 + contrast): showing a small ring-enhancing lesion with mild surrounding edema adjacent to the ventricular catheter and ventricular dilatation- Another

Source

Mean Arterial Pressure is equal to

(Systolic-Diastolic)/3+diastolic

(Systolic+ Diastolic)/3+diastolic

(Systolic-Diastolic)/8+diastolic

(Systolic-Diastolic)/8-diastolic

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Answer: (Systolic-Diastolic)/3+diastolic

Cerebral Vasodilatation is caused by

DecreasedPaO2 and Decreased Pa CO2

Decreased PaO2 and Increased Pa CO2

Increased PaO2 and Increased Pa CO2

Increased PaO2 and Decreased Pa CO2

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Answer: Decreased PaO2 and Increased Pa CO2

Interruption of Blood Brain Barrier is characteristic of the following type of brain edema

Cytotoxic

Interstitial

Vasogenic

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Answer:Vasogenic

Periventricular diffusion of CSF is characteristic of the following type of brain edema

Cytotoxic

Interstitial

Vasogenic

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Answer: Interstitial

Intracellular swelling of neurons is characteristic of the following type of brain edema

Cytotoxic

Interstitial

Vasogenic

--------------------------

Answer: Cytotoxic

Which of the following is an early indication of Increased Intracranial Pressure?

  • Dilated pupil

  • No pupillary reaction

  • Papilledema

  • Ptosis

--------------------------------

Answer: Ptosis

Which is the best position for a patient to maintain optimum intracranial pressure?

Extreme hip flexion

Lateral flexion of neck

Neutral position of the head

Trendelenburg position

--------------------------------------------

Answer: Neutral position of the head

How to Manage a Patient with Increased Intracranial Pressure?

  • Close monitoring of vital signs and assessment with Glasgo Coma Scale

  • Ensure adequate airway, ventilation and circulation,

  • Adequate analgesia and sedation

  • 300 head elevation unless contraindicated

  • ICP monitoring

  • Hyper oxygenation to prevent hypoxia

  • Hyperventilation(Controversial as it can induce brain hypoxia. Some people prefer to keep the PCO2 low around 30 mm of Hg)

  • Osmotic Diuretics

  • Seizure Control

  • Neuromuscular blocking agents

Other measure like temperature control, use of barbiturates, high protein high calorie diet (unless contra indictated ) are also very important.

Surgical measures like decompression craniectomy or a shunt to drain the CSF may be beneficial in some patients.

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2 comments

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thumbi7 3 months ago from India Author

Thank you for the comment @ladyguitarpicker


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ladyguitarpicker 3 months ago from 3460NW 50 St Bell, Fl32619

Great article with lots of important information, that is very useful. I understand that the Pet scan is the only way to check for Parkinson disease. Thanks Stella

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