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Raised ICP and Brain Herniation

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Abstract

A 28 Y/M, presented in emergency room with a severe traumatic head injury after being in a motorcycle accident without wearing a helmet. The physical examination revealed a Glasgow Coma Scale of 6, decerebrate posturing, pupils bilaterally fixed and 4 mm in size, and cerebral spinal fluid otorrhea on the right side. Computed tomography of the head showed left frontal and temporal subdural haemorrhage and underlying contusion with 8-mm midline shift, effacement of the suprasellar cisterns and effacement of the 3rdand 4th ventricles. Systemic examination revealed bradycardia, and hypertension with an initial blood pressure of 221/105 mm Hg.

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Author information

Authors and Affiliations

  1. Postgraduate Medical Education and Research, Chandigarh, India

    Kiran Jangra, Hemant Bhagat & Nidhi Panda

Authors
  1. Kiran Jangra
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  2. Hemant Bhagat
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  3. Nidhi Panda
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Editor information

Editors and Affiliations

  1. Division of Neuroanaesthesiology, Department of Anaesthesiology and critical care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

    Prasanna Udupi Bidkar

  2. Senior consultant and Head, Neuroanaesthesiology & Neurocritical care, MGM Healthcare Pvt Ltd, Chennai, Tamil Nadu, India

    Ponniah Vanamoorthy

Multiple Choice Questions

Multiple Choice Questions

  1. 1.

    Which of the following statements is not true regarding raised intracranial pressure?

    1. (a).

      Normal values of ICP range from 10 to 15 mmHg in adults

    2. (b).

      Normal values of ICP range from 7 to 8 mmHg in full term infants

    3. (c).

      The values higher than 20–25 mmHg need to be treated

    4. (d).

      The values more than 40 mmHg can be immediate life-threatening

  2. 2.

    The following statements are true regarding signs and symptoms of raised intracranial pressure, except.

    1. (a).

      Cushing's triad includes: hypertension, bradycardia and irregular respiration

    2. (b).

      Subfalcine herniation may lead to contralateral leg weakness

    3. (c).

      Central transtentorial herniation may lead to Diabetes insipidus in late stages

    4. (d).

      Uncal herniation presents as decorticate and decerebrate posture and Cheyne-Stokes respiration

  3. 3.

    Which of the following is not a radiological finding of raised intracranial pressure

    1. (a).

      Loss of sulci-gyri and grey-white matter distinction

    2. (b).

      Effacement of lateral ventricles

    3. (c).

      Opening of perimesencephalic cisterns

    4. (d).

      Midline shift

  4. 4.

    Which of the following is true regarding intracranial pressure monitoring?

    1. (a).

      Subarachnoid bolt should be zeroed at the level of external auditory meatus

    2. (b).

      Intraparenchymal catheter is considered as gold standard technique

    3. (c).

      Intraparenchymal can be re-zeroed after insertion

    4. (d).

      Intraventricular catheter must be re-zeroed each time the level of the patient’s head is altered

  5. 5.

    All of the following can cause secondary brain damage, except.

    1. (a).

      Hypothermia

    2. (b).

      Hypoxia

    3. (c).

      Severe Hypocapnia

    4. (d).

      Hypovolemia

  6. 6.

    Which of the following statement is true regarding initial management of raised intracranial pressure

    1. (a).

      Adequate cerebral perfusion pressure should be maintained at first place

    2. (b).

      Positive end-expiratory pressure must be avoided as it increases intracranial pressure

    3. (c).

      Airway, breathing and circulation should be managed initially in all the cases prior to raised intracranial pressure

    4. (d).

      Glasgow Coma Scale of more than 8 is an indication of securing the airway

  7. 7.

    All of the following can impede the cerebrospinal fluid drainage, except.

    1. (a).

      Abdominal compartment syndrome

    2. (b).

      Tight cervical collar

    3. (c).

      30° head elevation

    4. (d).

      Hemothorax

  8. 8.

    Which of the fluids should not be used in initial resuscitation of patients with raised intracranial pressure

    1. (a).

      Plasma-lyte-A

    2. (b).

      25% Dextrose

    3. (c).

      Normal Saline

    4. (d).

      7.5% saline

  9. 9.

    Which of the following treatment modality in not included in tier-1?

    1. (a).

      Mannitol

    2. (b).

      Hypertonic saline

    3. (c).

      Hyperventilation

    4. (d).

      Hypothermia

  10. 10.

    Following are true about hypothermia, except.

    1. (a).

      It reduces cerebral metabolism beyond the isoelectrical activity

    2. (b).

      There may be rebound severe intracranial hypertension during rewarming

    3. (c).

      Moderate to severe hypothermia is beneficial in reducing intracranial pressure

    4. (d).

      There is a risk of severe dyselectrolytemia during rewarming phase

Answers: 1. (b), 2. (d), 3. (c), 4. (d), 5. (a), 6. (c), 7. (c), 8. (b), 9. (d), 10. (c)

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Jangra, K., Bhagat, H., Panda, N. (2020). Raised ICP and Brain Herniation. In: Bidkar, P., Vanamoorthy, P. (eds) Acute Neuro Care. Springer, Singapore. https://doi.org/10.1007/978-981-15-4071-4_7

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  • DOI: https://doi.org/10.1007/978-981-15-4071-4_7

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-4070-7

  • Online ISBN: 978-981-15-4071-4

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