Last Updated on July 19, 2022
Introduction
Causes
Clinical Features
Presentation
• Altered mental status e.g. due to acute massive haemorrhagic stroke / intracranial bleed due to trauma etc.
Symptoms
• Headache
• Vomiting
Signs
• Cushing’s response: bradycardia + elevated BP
• Altered GCS / Drowsiness
• Irritability
• Pupil changes
Investigations
Imaging
CT brain
• Effacement of the ventricles, basal cisterns and other CSF spaces
• Loss of grey-white matter differentiation
• Brain herniation
Reference: Radiopedia
Management
Aims
• To reduce ICP and to maintain CPP
• To treat underlying causes
Immediate management
• Elevate head of bed to 30 – 40°
• If hypotension, to correct hypotension, aim MAP >90 mmHg
• If intubated, hyperventilate to aim pCO2 to 26 – 30 mmHg
• Consider sedation, hypothermia
• Arrange for CT brain
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Reference: Oxford Handbook of Clinical Medicine 10th ED
Definitive management
• Depends on the underlying cause
• Refer Neurosurgery for craniotomy / Burr hole e.g. in intracranial haematoma