Increased Intracranial Pressure

• Increased ICP


  Increase in intracranial bulk due to increase in any of the major intracranial components: brain, blood, csf.
• Factors that increase intracranial bulk:

  Brain tissue

  • trauma
  • tumor
  • infection
  • swelling
• Factors that increase intracranial bulk: 


  Blood

  • cerebral hemorrhage
• Factors that increase intracranial bulk: 


  CSF

  • obstruction (tumor)
• Pathophysiology:

  Infection, trauma, injury - vasodilation - decreased perfusion - cerebral hypoxia - restlessness (earliest sign) and irritability
• Pathophysiology:

  Infection, trauma, injury - vasodilation - decreased perfusion - cerebral hypoxia - anaerobic respiration - (+) lactic acid - nerve irritation - pain - headache
• Pathophysiology:

  Infection, trauma, injury - vasodilation - decreased perfusion - cerebral hypoxia - neural response - decreased electrical activity - hyperexcitation - seizure
• Pathophysiology:

  Infection, trauma, injury - vasodilation - increased pressure - brainstem - decreased rr
• Pathophysiology:

  Infection, trauma, injury - vasodilation - increased pressure - brainstem - anisocoria
• Anisocoria

  Unequal pupils
• Pathophysiology:

  Infection, trauma, injury - vasodilation - increased pressure - Cranial Nerve 9 compression - projectile vomiting
• Pathophysiology:

  Infection, trauma, injury - vasodilation - increased pressure - increased hydrostatic pressure - decreased onchotic pressure - fluid shift - cerebral edema
• Oncotic pressure is the pressure exerted by proteins (primarily albumin) in the blood plasma that helps retain fluid within the blood vessels.
• The hydrostatic pressure is the pressure exerted by the fluid within the blood vessels.
• Pupils: fixed and dilated
• Cushing's Triad:

  • Hypertension
  • Bradycardia
  • Bradypnea
• There is ipsilateral (same side) pupil dilatation. eg. leftbrain affectation, left pupil is dilated.
• Decorticate posturing: flexion at elbow with extension at wrist
• Decerebrate posturing: extension at elbow and wrist
• Increased ICP: Management

  Pharma:

  • Cerebral Edema - Mannitol
  • NR: Monitor BP
  • SE: Hypotension (dt increase UO)
• Dexamethasone 


  The only corticosteroid that can cros BBB.
• Increased ICP: Management

  Pharma:

  • Cerebral Swelling - Dexamethasone
  • NR: Monitor for hyperglycemia and infection
  • Infection: Reverse isolation
• Contraindication of increased ICP: Lumbar puncture
• Increased ICP: Management


  Monitor NVS every 1 to 2 hours.
• Increased ICP: Management


  Avoid factors that can increase ICP:

  1. coughing - antitussives
  2. sneezing
  3. stooping
  4. gag reflex - diet: soft; ngt
  5. straining - laxatives
• Increased ICP: Management

  Position: HOB 30 to 45 degrees; Caution: do not elevate at 90 degrees can cause herniation. No flexion of neck and hips.