Raised ICP

from cerebral autoregulation

Etiology: whole brain or focal raised ICP?

types of cerebral oedema

  • vasogenic
    • etiology: tumours, infection, inflammation, PRES, central venous thrombosis
    • pathophys: disruption of BBB
    • these ones respond to steroids
  • cytotoxic
    • etiology: focal ischaemic stroke, hypoxic-ischaemic brain injury, prolonged seizures, liver failure
    • pathophys: neuronal swelling → cell death
  • osmotic
    • etiology: acute hyponatraemia, rebound oedema
    • +/- other causes of oedema
  • hydrostatic
    • etiology: hydrocephalus

Early compensation - CSF driven from brain to spinal cord

clinical presentation

classic ↑ ICP headache:

  • worse in the morning
  • improves with mobilisation
  • but isolated/longstanding headache are rarely due to an underlying focal lesion

Cushing's reflex

#icu #neurology

types of oedema - pivot table

Type → Vasogenic Cytotoxic Interstitial
Pathophys
Radiologic findings - CT scan: Hypoattenuation.
- MRI:
- Hyperintensity on T2/FLAIR, without diffusion restriction.
- Contrast enhancement due to loss of the blood-brain barrier.		 - CT: Hypoattenuation +/- loss of grey/white junction.
- MRI: diffusion restriction = hyperintensity on DWI sequences and hypointensity on ADC sequences.		 hydrocephalus with edema surrounding the ventricles
Treatment approach Steroids Surgical if applicable

Brain injury
Neuroprotection in critical illness

https://emcrit.org/ibcc/icp/
https://emcrit.org/ibcc/pres/