I wish other online resources taught the subject more clinically like you did

My transcript notes of the video: 00:04 So with anything about intracranial hypertension raised intracranial pressure and if the patient's conscious they'll complain of some symptoms at any time but patience has a blow to the head it's not surprising to get a headache 00:21 the pain arising largely from the blood vessels and probably from the meninges as well actually it could become nauseated and there can be vomiting there can be drowsiness and confusion disorientation and these patients can be 00:39 very agitated it must be awful having about that injury because of the agitation the patient suffers it's often quite extreme and you might know yourself you've been activated because you've had a fever or something it's a 00:51 very unpleasant feeling seizures while fixing can occur anytime there is insult to the central nervous system so it's always worth keeping an eye out for seniors you could have booked up and decides actually in other places neck 01:08 stiffness and back pain these can be caused by involvement of the meninges back pain and neck stiffness can mean meningeal involvement as a complication of the intracranial hypertension signs of course of things that you see about 01:30 patient and the classic one that we observe for is reduced levels of consciousness and we measure levels of consciousness with the Glasgow Coma Scale so Glasgow Coma Scale we will decrease with raises in intracranial 01:47 pressure and if the intracranial pressure goes over 40 millimetres of mercury we can expect substantial decreases in the level of consciousness substantial falls in the Glasgow Coma Scale school going down from a normal of 02:04 15 to much lower values also there can be third nerve compression the third nerve is the oculomotor nerve that controls the pupils so the pupils first of all will respond to light sluggishly then will not respond to light and will 02:22 become dilated eventually the pupil on one side can become fixed and dilated and the something called the Cushing's reflex triad Cushing was an American neurosurgeon and he noticed that 02:36 patients who had severe raised intracranial pressure they had three symptoms first of all they had Braca kardea they had hypotension and it was a wide pulse pressure a very big gap between the 02:53 systolic and the diastolic blood pressure so the systolic blood pressure would rise very high without such a live proportional rising the diastolic blood pressure but also there can be irregular respirations but I want to tell you 03:12 something that's very important now that a lot of people looking after places with head injuries often don't realize and that is the order in which these signs will represent the first one to present will be the reduction the 03:26 Glasgow Coma Scale after that there will be loss of the pupillary reflexes and a pupil on one side can become fixed and dilated and of course you might remember that the pupil that becomes fixed and dilated is on the same side as the 03:43 space-occupying lesion the oculomotor nerve is compressed is the oculomotor nerve is compressed underneath the space-occupying lesion that stops it from working that stops it from constriction the people 03:59 but that will happen after there is a decrease in Glasgow Coma Scale and if someone has a fixed and dilated pupil that person is already in a highly life-threatening situation this is a serious serious surgical 04:16 emergency so don't think that because your patients pupils are reacting normally this patients absolutely fine this is a late feature it's a very serious future what we need to look for first is any reduction in the Glasgow 04:31 Coma Scale because that will happen first and hopefully we detect the raised intracranial pressure before the oculomotor nerve is compressed ideally we prevented if the oculomotor nerve is compressed and there's a fixed dilated 04:46 pupil that patient is a very variable and the Cushing's reflex the high systolic blood pressure the Bradley kardia and the white pulse pressure are all very very late features these are almost what you call pre coning features 05:04 that basically mean the patient could die at any moment they are very late very serious features as is the irregular respiration so don't think that the patient's pulse is okay therefore the patient's okay don't think 05:18 that because the patient's blood pressure is normal this patient is fine don't think that because the pupils are reacting normal in this patient's fine these are light features look for the reduction in Glasgow Coma Scale then 05:31 you'll get the alterations in the pupillary reflex and the fixed dilated pupils and then you'll get the Cushing's triad but the Cushing's triad is almost upon you to the death of that patient so clinically it's not particularly useful 05:43 the thing to look for is the reduction in the Glasgow Coma Scale be vigilant about that and remember a reduction of one in the Glasgow Coma Scale is clinically significant and must be reporting and must be explained 06:03 now this graph shows what happens as intracranial pressure starts to rise now if there's a space occupying lesion that will get bigger and would the space occupied illusion will start taking up more space so if we imagine the 06:20 situation here where we have the jaw surrounding the brain and as you know it goes down the spinal cord as well forming the drill sound now if there's a space occupying lesion which is expanding in here it's going to take 06:39 with progressively more and more space but as this takes up more more space there is not going to be a significant increase in intracranial pressure therefore as this takes up more more space because there's not significantly 06:58 increasing intracranial pressure there's not going to be a significant reduction in Glasgow Coma Scale and that means we can't detect this unless we scan this patient because what happens is as the space occupied illusion increases in 07:15 size this actually displaced his cerebral spinal fluid from the cerebral part and the Stoke of spinal fluid and he pushes it down the way into the spinal sac the dural sac in the spinal cord so what happens is that the drill 07:33 suck in the spinal cord actually blows out and gets bigger because the dura mater is fairly thick and tough around about the brain but that same dura mater well it's continuous is actually much thinner down here in the spinal regions 07:50 so you get displacement to sober spinal fluid from the cerebral area down to the spinal area and that compensates so there's compensation for an expanding space occupying even and To get the full transcript and PDF with screenshot - get Askify chrome extension

Thank you for this series of videos on head injury and intracranial pressure - I have found them most helpful whilst revising for my ED exams.

very helpful and very clinical teaching, may Allah grant you happiness and guidance and i really hope you see all this amazing work in hereafter also!

Fantastically useful video! Thank you!

Top-notch conceptual correlation and beautifully crafted and articulated session. Thank you so much, Sir. 19/JUNE/2022,SUN, 1.54pm IST

Love the video, u didnt say anything about CT scan showing hematoma. How to diffetentiate epidural from subdural from a tumor. What striking features u can pick on the CT scan of a patient with subdural hematoma. I had a exam that ask about 5 features u can get on CT Scan. and the type of hematoma when u look at CT scan

And also how can u treat the patient in emergency setting. An elderly that had a fall and started bleeding intracranially. How wd u save his life both medically and surgically

Thank you!

Is there any way to self-diagnose one’s ICP?

Thank you.

Thanks