Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...
ย
Management of Raised Intracranial Pressure
1. Presentation & Management of
Raised Intracranial Pressure
By
Zain Alabedeen B. Jamjoom, M.D.
Professor of Neurosurgery
2. Normal Intracranial Pressure
Normal ICP ~10 mmHg
(supine at the level of the foramen of Monro)
Pulsatile
Fluctuates with the respiration
ICP >20 mmHg is definitely pathological
20 November 2007 Raised ICP 2
4. Cerebral Blood Flow (CBF)
Pressure
Flow =
Resistance
CBF = Cerebral perfusion pressure (CPP)
Cerebral vascular resistance (CVR)
CPP = Mean syst. art. BP - Mean ICP
20 November 2007 Raised ICP 4
5. Intracranial Cavity
Its volume is virtually constant.
It is filled to capacity with fluids & solid
material that are non-compressible.
Therefore:
Increase in one constituent or an
expanding mass within the intracranial
space results in raised ICP (Monro-Kellie
Doctrine).
20 November 2007 Raised ICP 5
6. Intracranial Cavity
Content
Brain:
โ Neurones 500 - 700 ml
โ Glia 700 - 900 ml
โ Extracellular fluid 100 - 150 ml
Blood: 100 - 150 ml
Cerebrospinal fluid: 100 - 150 ml
Constituents are non-compressible
but partially displaceable
20 November 2007 Raised ICP 6
8. Intracranial Cavity
3 compartments
2 supratentorial
spaces, separated
by the falx cerebri,
and
1 infratentorial
space, separated
from supratentorial
spaces by the
tentorium.
20 November 2007 Raised ICP 8
30. Brain Abscess
Develop as a result of a localized
bacterial cerebritis followed by necrosis
and encapsulation.
Mechanisms:
โ Hematogenous
โ Extension from neighbouring structures
โ Penetrating injuries
Symptoms of infection may be absent in
50% of cases
20 November 2007 Raised ICP 30
31. Treatment of Raised ICP
General measures for reducing
raised ICP
Definitive treatment:
Removal of the cause
20 November 2007 Raised ICP 31
32. General Measures to Reduce Raised ICP
o
Head elevation 30o up in neutral position.
Diuretics:
โ Mannitol : 20% 1g/kg iv single dose or
0.25-0.5g/kg Q8h
โ Furosemide : 1mg/kg iv sinlgle dose or
0.25-.05mg/kg Q8h
Normovolemia: IV infusion of cristalloid
Controlled hyperventilation:
โ pCO2 reduction to 30 - 35 mmHg.
Sedation & Muscle relaxation.
CSF withdrawal. No lumbar puncture
20 November 2007 Raised ICP 32
47. Measurement of Intracranial
Pressure Indications
Severe head trauma
Intracerebral hemorrhage
Extensive cerebral edema
โ e.g. after infarct, hypoxia, intoxication, etc.
Following major intracranial operations
In the assessment of dementia and
benign intracranial hypertension
20 November 2007 Raised ICP 47
48. References
Essential Neurosurgery
by: Andrew Kaye
Neurology and Neurosurgery Illustrated
by: Lindsay - Bone - Callander
20 November 2007 Raised ICP 48