INCREASED INTRACRANIAL

PRESSURE

11ou
 VOLUMES

BLOOD VOLUME: 1000 ML

(20% oF TOTAL TO BRArN)

BRAIN TISSUE BULK:

1300-1400 GRAMS
3 POUNDS

CEREBRAL SPINAL FLUID:

90-150 ML
(0.35 MLnUIN OR 500 ML/DAY)
 Cerebral spinal fluid
produced
in
4 ventricles of the brain
by
choroid plexi

Circulates in the subarachnoid

space
 Why do volumes increase?

rrssti#ftft
ruMoRS
-CEREBRAL EDEMA
(Increase water content in brain's
white matter)
-TRAUMA

:;,RhT,'#,'#iffifff
{csrt
-tpnoDucrroN
. BLOCKAGE OF
CIRCULATION

tnr"?}ilt8*' voLUME
VASODILATION FROM
t co2
 COMPENSATORY
MECHANISMS
FAIL QUICKLY

THIS RESULTS IN
INCREASED PRESSURE

QvoLUME -t**EssuRE)
 TT{E RESULTS OF
INCREASED
INTRACRANIAL
PRESSURE ARE:

-TISSUE ISCHEMIA
.TISSUE COMPRESSION
 IF PRESSURE IS NOT
RELIEVEI)O THE BRAIN
HERNIATES AND THE PERSON
DIES.
THERE ARE TWO \TAYS THE
BRAIN CAN HERNIATE

-anterior (supratentorial) fossa

(temporal lobe)

-posterior (subtentorial) fossa

(midbrain)
LATE,RAL
HERNIATION

?k?k*First sign is
unilateral
pupil dilation

(Oculomotor nerve:
3td cr n.)
 HERNIATION HAPPENS
WHEN THE BRAIN PRESSES
THROUGH THE ONLY
OPENING IN THE SKULL:

THE FORAMENMAGNUM
 SIGNS AND SYMPTOMS OF
INTRACRANIAL PRESSURE

Symptoms depend on location and

cause of increased pressure.
and
How fast the increased pressure
develops. (bleeding vs tumor)
 rre increases
different parts of the brain
are affected.
-Vasomotor center
-Posterior cerebral artery
-Oculomotor nerYe
-Cortico spinal nerve
pathway
-Ascending reticular
activating system
(RAS)

Pressure on these areas

produce symptoms.
First symptoms:

-changes in behavior

then

-changes in level of
consciousness
STAGES:
#l Diencephalon
Impairment:
?k
?k ?k ?k ?k
FifSt Sympt0m :
changes in loc
(RAS)
-subtle behavioral A
agitation, apathy, lethargy
(stupor, coma)
restles sn es s : dis o rien tatio n

Need more stimulation to

elicit a response
then r

-I?
headache

projectile Yomiting
(without nausea)
Eyes: oculomotor nerve
*****changes in vision:
r increase in blind spot
-pupils small but react
to light
-roving ocular movement
-rray have diplopia
-papilledema (optic disk
a

choked)
STAGE #2: MIDBRAIN

As pressure further f,
midbrain and upper pons
function decreases.
Brain-stem failure

-Respirations:
Cheyne-Stokes progress
to central neurogenic
hyperventilation
-Pupils:
Fixed and dilated
Fixed at midpoint
*****Changes in respirations
(medulla & pons)

-pauses, sighs, yawns may

interrupt respirations

-eventually C heyne-Stokes
POSTURING:

-flexion: decorticate

7"os