Increased intracranial pressure is caused by an increase in the volume of brain tissue, cerebrospinal fluid, or blood within the skull. The Monro-Kellie hypothesis states that this closed space cannot accommodate increases in volume, so any increase must be balanced by decreases elsewhere. Left untreated, increased ICP can cause brain herniation, compression, and death. Treatment focuses on reducing volume through medications, surgery, positioning, and monitoring for effectiveness.
Increased intracranial pressure is caused by an increase in the volume of brain tissue, cerebrospinal fluid, or blood within the skull. The Monro-Kellie hypothesis states that this closed space cannot accommodate increases in volume, so any increase must be balanced by decreases elsewhere. Left untreated, increased ICP can cause brain herniation, compression, and death. Treatment focuses on reducing volume through medications, surgery, positioning, and monitoring for effectiveness.
Increased intracranial pressure is caused by an increase in the volume of brain tissue, cerebrospinal fluid, or blood within the skull. The Monro-Kellie hypothesis states that this closed space cannot accommodate increases in volume, so any increase must be balanced by decreases elsewhere. Left untreated, increased ICP can cause brain herniation, compression, and death. Treatment focuses on reducing volume through medications, surgery, positioning, and monitoring for effectiveness.
Increased intracranial pressure is caused by an increase in the volume of brain tissue, cerebrospinal fluid, or blood within the skull. The Monro-Kellie hypothesis states that this closed space cannot accommodate increases in volume, so any increase must be balanced by decreases elsewhere. Left untreated, increased ICP can cause brain herniation, compression, and death. Treatment focuses on reducing volume through medications, surgery, positioning, and monitoring for effectiveness.
ICP. • 2. Recognize the clinical manifestations of increased ICP. • 3. Explain the management of increased ICP in terms of medical, pharmacotherapy, surgical and collaborative management. INTRACRANIAL PRESSURE (ICP)
volume of 3 essential components: 1. CSF, 75ml 2. BLOOD VOLUME, 75ml 3. CNS TISSUE, 1400g o Normal ICP is between 8-15mmHg. o 3 components maintain a state of equilibrium. o The intact cranium cannot be expanded • Monro-Kellie hypothesis: because of a limited space for expansion within the skull, an increase in any one of the components causes a change in the volume of the others. ✔ Any increase in one of the elements must be balanced or compensated by a proportional constriction either or both of the other components Increased Intracranial Pressure (IICP) • A syndrome characterized by increase in the amount of CNS tissue, CSF fluid or blood leading to an ICP greater than 15mmHg. • Once ICP reaches around 25mmHg marked elevation in ICP will be noted. CAUSES PATHOPHYSIOLOG Brain Tissue/ Y CSF/ Blood Volume No room for expansion Compliance (Monro-Kellie Hypothesis)
Displacement of CSF ↓ Blood flow in the
into Spinal Cavity brain
Can only accommodate Can only maintain decreased
CSF to a certain point blood flow for a period of time
Limit reached Acidotic Cerebral Metabolism
IICP Acidotic Env. Causes Cerebral Swelling
Worsening Cerebral Hypoxia and Ischemia
De Brain Herniation
at De Brainstem Compression
h at Increased ICP can impede the circulation to the brain, stimulates further swelling, impede the absorption of CSF, affect the functioning of nerve cells, & lead to brainstem compression & death May shift brain tissue, resulting in herniation, a frequently fatal event Clinical Manifestations **When ICP increases to the point where the brain’s ability to adjust has reached its limits, neural function is impaired. (changes in LOC) ✔ Lethargy - earliest sign ✔Sudden change in condition ✔Pt. becomes stuporous & may react only to loud auditory or painful stimuli. ✔When coma is profound, pupils are dilated & fixed, respirations are impaired----death. ✔CUSHING’S TRIAD ▪ HYPERtension + Widening Pulse Pressure ▪ BRADYcardia ▪ BRADYpnea Assessments • Headache • Vomiting • Diplopia (CN VI) • Body temperature may be elevated or subnormal • Pupillary changes Diplopia • Papilledema- swelling of optic nerve • Lateralizing sign- this is a contralateral loss of motor function due to decussation of motor fibers at the level of medulla oblongata. • Pupillary Changes: ▪ Ipsilateral pupil dilatation (CN 3 compression) ▪ Bilateral pupil dilatations Pupillary Changes
anisocoria Unilateral pupil dilatation • Brainstem function impairment ✔Doll’s eye phenomena- abnormal when present & may occur as the client begins to experience a decrease in LOC. Occurs when the client’s head is moved from side to side & the eye remain in a fixed midline position ✔Decortication ✔Decerebration DIAGNOSTICS CT scan, MRI, cerebral angiogram, EEG, Caloric test (oculovestibular response) FORMULA ICP monitoring device: ✔Purpose: to identify increased pressure early in its course, to quantify the degree of elevation, to initiate appropriate treatment, to provide access to CSF for sampling & drainage, to evaluate the effectiveness of treatment ✔ 3 ways to measure ICP: • Intraventricular catheter- most accurate • Subarachnoid/Subdural screw/bolt • Epidural Sensor MEDICAL MANAGEMENT **Increased ICP is a true emergency & must be treated promptly. Goals: ⮚ Invasive monitoring of ICP ⮚ Decreasing cerebral edema ⮚ Lowering the volume of CSF ⮚ Decreasing cerebral blood volume while maintaining cerebral perfusion ⮚ Pharmacologic therapy ⮚ Patient requires care in the critical care unit. PHARMACOTHERAPY • Diuretics (mannitol, lasix) • Anticonvulsants (valium, dilantin, phenobarbital, tegretol) • Antipyretics • Muscle relaxants • BP medication • Corticosteroids - Decadron (dexamethasone) • Antacids/H2 receptors • Anticoagulants • Stool softener • Intravenous fluids • Electrolyte replacement
Note: Opiates & sedatives are contraindicated to the client
with IICP. - induce cerebral hypoxia and vasodilation Treatment & Collaborative Management • Adequate oxygenation/ Maintain respiratory function • Position: Semi- fowlers • Protect patient from injury • Avoid factors that increases ICP (Nausea and vomiting, sneezing and coughing, valsalva maneuver, over suctioning, restraints, rectal examination, enema, flexion of waist, hip or neck) • Control fever • Monitor intake & output • Limit fluid intake to 1200ml/day SURGICAL INTERVENTIONS
• Ventriculoperitoneal shunt- shunts
CSF from the ventricles into the peritoneum • Craniotomy for space occupying lesions and cerebral hematoma Complications • Herniation • Seizures • Cognitive deficits • Motor deficits • Sensory deficits • Coma • Death FIN
