440 Final-Acute Brain Injury
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Symptoms of Increased ICP: Change in LOC
Result of impaired CBF which deprives cells of the cerebral cortex and the reticular activating system (RAS)-in brainstem of oxygen. Interruptions of impulses from the RAS can cause unconsciousness
Symptoms of Increased ICP: Changes in vitals
- caused by increase pressure on hypothalamus, thalamus, pons, & medulla
- Cushing's Triad appears after ICP has been increased for some time. Change in temp also possible
Symptoms of Increased ICP: Ocular signs
- compression of cranial nerve III (oculamotor nerve) results in dilation of pupil on same side as lesion; sluggish or no response to light, inability to move eye upward, & ptosis of eyelid.
- -These can be signs of brain moving away from midline (a fixed unilateral dilated pupil is a neuro emergency-herniation!)
Symptoms of Increased ICP: Decrease in motor function
- Changes in motor ability as ICP rises.
- A contralateral (oppisite side of lesion), hemiparesis may develop. Noxious stimuli may elecit decorticate (flexion) or decerebrate (extension) posturing
Internal rotation and adduction of arms with flexion of elbow, wrists, and fingers as a result of interruption of volunatary motor tracts in cerebral cortex
- disruption of motor fibers in midbrain and brainstem
- Arms stiffly extended, adducted and hyperpronated, Indicates more serious damage!
CPP (Cerebral perfusion pressure)
- Reflects amount of blood flow from systemic circulation required to provide adequate glucose and oxygen for brain metabolism
- Done at bedside by decreasing the MAP from the ICP
- Normal CPP=60-100mmHg
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