#drnajeeb #IntracranialPressure #bloodpressure
Symptoms Of Raised Intracranial Pressure | Dr Najeeb Lectures
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Symptoms of Raised Intracranial Pressure. Short Video Clip description
Raised Intracranial pressure (ICP) is an absolute contraindication to performing a Lumbar Puncture (LP). If an LP is performed on a person suffering from raised ICP his/her brain can herniate through the Foramen Magnum and get crushed resulting in instant death.
The question is that how will we can know if a person has raised ICP.
There are 5 signs/symptoms of raised ICP, which are described in detail below:
1-If a patient has a history of unexplained HEADACHE; especially in the morning; then this point alone significantly raises suspicion of raised ICP.
2-PAPILLEDEMA is the second most definitive sign of raised ICP; it can be observed during routine Ophthalmoscopy. A normal Pupil or Optic Disc is seen to be having sharp margins whereas In raised ICP boundaries of Optic Disc are blurred due to edema.
Reasons for Raised ICP are enumerated:
Severe Meningitis, Encephalitis, Intracranial Tumors, Intracranial Hemorrhage, Space Occupying Lesion (SOL) in cranial cavity. LP is contraindicated in all these conditions.
Why raised ICP causes Papilledema?
Whenever there is a tumor, a swelling or an inflammation of the meninges; pressure in cranial cavity goes up since the cranial cavity is non-expandable. Dura Mater, makes a sleeve around the Optic Nerve on its way to the eye socket; this means that CSF is also going around the Optic Nerve as it traverses through the skull.
[The reason for this is that the Optic Nerve is not actually a nerve embryologically; but a CNS tract! Myelin sheath of Optic Nerve has Oligodendrocytes instead of Schwann cells; like any other CNS tract. Similarly, diseases of Schwann Cells affect all peripheral Nerves except the Optic N.]
Retinal Artery pierces the Dura Mater of Optic Nerve; passing through Subarachnoid space; and traverses Pia mater and then gives branches at the retina. Central Retinal Vein also follows a similar path; piercing all the same structures around the Optic Nerve. Therefore, when ICP is high due to any reason it translates into an increase in pressure of Intracerebral Fluid (ICF).
Arterial blood pressure is naturally high so if there is raised ICP, the retinal artery is STILL able to pass its contents through and supply blood to Retina BUT retinal veins (having low pressure) which are responsible for draining the blood back, are easily compressed by the high pressure of CSF.
This inability to drain the blood back from the retina leads to increased pressure in the microcirculation of retina; hence edema develops around optic disc resulting in what we see as PAPILEDEMA; also, another minor contribution to increased ICP is CSF tracking through nerve bundles; further adding to the Papilledema.
3-PROJECTILE VOMITING: Raised ICP disrupts the GIT-Regulating Center in Medulla and disturbs the Vagus Nerve as the brain is herniating a little bit downwards. Since Vagus N. normally regulates the motility of GIT; if it starts over firing; Retro propulsion may occur leading to projectile vomiting. It’s called "projectile" because the vomit comes out with a high pressure that is enough to propel it forward some distance, maybe even a few meters. This type of vomiting is usually characteristic in small children; but never in adult life, with the exception of cases of raised ICP of course.
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