1. Increased Intracranial Pressure

2. Monro – Kellie hypothesis … Causes of ↑ ICP : - head injury
Normal ICP 10 to 20 mm Hg
Monro – Kellie hypothesis …
Causes of ↑ ICP : -
head injury
brain tumours,
subarachnoid haemorrhage, and
toxic and viral encephalopathies.
Increased ICP
decreases cerebral perfusion,
stimulates further swelling (oedema), and
shifts brain tissue through openings in the rigid dura, resulting in herniation – a serious problem
Monro-kellie hypothesis states that because of the limited space for espansion within the skull, an increase in any one of the odmponents causes a change in the volume of the others. Because brain tissue has liited space to change compwnsation typically is accomplished by displacing or shifting csf increasing the absorptionof csf, or dedcreasing cerebral blood volume without such changes , icp will begin to rise.

3. Cushing’s response
↑ ICP → decreased perfusion of brain tissue → vasomotor centre increases systolic pressure of blood – heart rate decreases – immediate intervention is needed
At a particular level the ability to autoregulate the perfusion is lost leading to significant changes in mental status and vital signs.
Cushing’s triad The bradycardia, hypertension and bradypnoea asssociated with the deterioration

4. Clinical Manifestations
Stupor
Reacts only to loud auditory or painful stimuli
Coma
Abnormal motor responses in the form of decortication, decerebration ,flaccidity
Pupils dilate, get fixed
Respiration impaired
Death

5. A : decorticate rigidity B: decerebrate rigidity

6. Assessment and diagnostic findings
Cerebral angiography
Computed tomography (CT) scanning
Magnetic resonance imaging (MRI)
Positron emission tomography
Transcranial doppler studies
Lumbar puncture is avoided because sudden release of intracranial pressure will cause herniation of the brain.

7. Papilloedema

8. Normal optic fundus

13. There are three main types of herniation.

16. Maintain a patent airway
Achieve an adequate breathing pattern
Optimizing cerebral tissue perfusion
Maintain negative fluid balance