Physiology

ICP (4-11 mmHg)

Presentation

• Headache
  • Thunderclap headache
  • Postural headache (gradual increase)
• Somnolence
• Confusion andDecreased LOC →Coma (GCS ≤ 8)
• Death
• Optic disc edema
• CN VI Abducens Palsy

Special Population

• Signs of Increased ICP

Causes

1. Obstruction of CSF (CSF)
   • !SAH - Subarachnoid Hemorrhage
   • Aqueductal stenosis
2. Increase in Intracranial content (BRAIN)
   • Brain Tumor
   • !ICH - Hemorrhagic Stroke, hematoma
3. Generalized Cerebral Edema (BLOOD)
   • TBI
   • !Ischemic Stroke → edema
   • HE - Hepatic Encephalopathy
   • !CVST - Cerebral venous sinus thrombosis

Symptomatic Management

1. Decreases CSF (Temporizing)
   1. EVD
   2. Decrease production: Acetazolamide (carbonic anhydrase inhibitors)
   3. Decrease brain interstitial fluid: Mannitol (osmotic diuretic)