Head Injury: Recognizing Increasing Intracranial Pressure
In a patient with a head injury, the earliest and most frequent sign indicating a rise in intracranial pressure (ICP) is a change in the level of consciousness.
Why Consciousness Changes First
- The brain's arousal centers, particularly the reticular activating system (RAS), are very sensitive to pressure.
- Even a small increase in ICP can disrupt RAS function, leading to subtle or obvious changes like drowsiness, confusion, lethargy, or even loss of consciousness.
- This change is often the first indicator that pressure is building inside the skull.
Other Manifestations
- Pupillary changes (like dilatation, often unilateral initially) usually indicate brainstem compression, typically occurring later than altered consciousness.
- Hemiparesis (weakness on one side of the body) suggests focal brain injury or herniation impacting motor pathways, which may also be a later sign compared to the generalized effect on consciousness.
Therefore, monitoring for alterations in the patient's awareness and responsiveness is crucial for early detection of increasing ICP.
Important Questions from Brain & Nervous System Surgery
Which of the following chromosomal abnormalities are associated with brain tumours?
1. Neurofibromatosis type 1
2. Neurofibromatosis type 2
3. Peutz-Jeghers syndrome
4. Hereditary nonpolyposis colorectal cancer
Select the correct answer using the code given below.
Consider the following clinical features:
1. Raised ICP
2. Seizures
3. Focal deficit
4. Headache
Which of the above clinical features are related to most brain tumours?
- The most common type of brain tumours associated with neurofibromatosis type 1 brain tumour syndrome is
Upper motor neuron lesions are characterized by which of the following?
1. Increased tone spasticity
2. Hyperreflexia
3. Absent plantar response
4. Motor weakness
Select the correct answer using the code given below.
A comatose patient after sustaining severe head injury has been admitted in neurosurgical ICU. Which of the following parameters should ideally be maintained in this patient ?
1. $pCO_2 = 4.5 – 5.0$ kPa ($33-38$ mm Hg)
2. MAP = $80 – 90$ mm of Hg
3. $pO_2 > 11$ kPa ($> 80$ mm Hg)
4. $Na^+ < 130$ meq/L
Select the correct answer using the code given below :
