CSF Production and Regulation of Intracranial Pressure
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intracranial pressure is a medical condition encountered in clinical setting resulting from traumatic injury of brain, RTA, ischemia, stroke & similar brain pathology. understanding of this condition is necessary for prompt identification & management at early stage.
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CSF Production and Regulation of Intracranial Pressure
- 2. STRUCTURES IN CRANIUM • BRAIN- 1400 gm • BLOOD- 75 ml • CSF- 75 ml
- 3. CEREBROSPINAL FLUID • TOTAL VOLUME- 140- 270 ml • RATE OF PRODUCTION- 0.2- O.7 ml/min or About 500- 700 ml/DAY • INTRACARANIAL PRESSURE- 5-15 mmHg = CSF PRESSURE WHEN LYING DOWN.
- 5. CAUSES OF INCREASED ICP INCREASED BRAIN VOLUME • SPACE OCCUPYING LESIONS • TUMORS • ABSCESS • HEMATOMA • CEREBRAL EDEMA • ENCEPHALITIS
- 6. CAUSES OF INCREASED ICP INCREASED BLOOD VOLUME • VASCULAR MALFORMATIONS • CEREBRAL VENOUS THROMBOSIS • MENINGITIS /ENCEPHALITIS • HYPOXEMIA • HYPERPYREXIA
- 7. CAUSES OF INCREASED ICP INCREASED CSF VOLUME • HYDROCEPHALUS • CHOROID PLEXUS PAPILLOMA • OBSTRUCTION
- 8. PATHOPHYSIOLOGY OF INCREASED ICP
- 9. INCREASED INTRACRANIAL PRESSURE DECREASED CEREBRAL BLOOD FLOW ISCHEMIA & CELL DEATH STIMULATION OF VASOMOTOR CENTERS CUSHING’S RESPONSE HYPERTENSION BRADYCARDIA BRADYPNEA
- 10. S. NO INCREASING ICP MANIFESTATIONS 1 COGNITION (SENSITIVE TO HYPOXIA) DISORIENTATION, RESTLESSNESS, CONFUSION 2 CRANIAL NERVES (MIDBRAIN & BRAINSTEM) II, III, IV, VI (OPTIC, OCCULOMOTOR, TROCHLEAR, ABDUCENS) 3 PYRAMIDAL TRACTS WEAKNESS IN ONE EXTREMITY OR ONE SIDE OF THE BODY 4 PRESSURE ON VENOUS & ARTERIAL VESSELS HEADACHE AGGRAVATED BY MOVEMENT OR STRAINING
- 11. MONITORING ICP
- 12. MANAGEMENT OF INCREASED ICP REDUCE CEREBRAL EDEMA REDUCE CEREBRAL BLOOD VOLUM E REDUCE CSF VOLUME
- 13. REDUCE CEREBRAL EDEMA Osmotic diuretics Fluid restriction corticosteroids
- 14. REDUCE CSF VOLUME DRAINING CSF
- 15. REDUCE CEREBRAL BLOOD VOLUME • CONTROLLING FEVER • MAINTAINING BP • OXYGENATION • REDUCING CELLULAR METABOLIC DEMANDS
- 16. MAINITAINING CEREBRAL PERFUSION • INOTROPIC AGENTS: DOBUTAMINE & NOREPINEPHRINE • IMPROVEMENTS IN CARDIAC OUTPUT • MAINTAIN CEREBRAL PERFUSION PRESSURE > 70 mmHg