Neurological deficits
Philip Woodrow in Nursing Acutely Ill Adults, 2015
Like intra-abdominal hypertension, intracranial hypertension is a pressure greater than >20 mmHg, and causes organ injury. The most common cause of intracranial hypertension is oedema (May, 2009). Traditionally, cerebral oedema has been removed with the osmotic diuretic mannitol (Gupta et al., 2010). But many neurologists now advocate hypertonic saline (see Chapters 25) (Kamel et al., 2011). Patients with cerebral oedema should be nursed at angles of 15–30 to optimise drainage through the jugular veins (Bahouth and Yarbrough, 2013).
Malignant brain neoplasms and brain metastasis
Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni in Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Signs and symptoms of brain tumors can be localized, related to the anatomic location of the lesion, or generalized, as a result of increased intracranial pressure, hydrocephalus, or meningeal irritation.Common localizing signs and symptoms include the following:Frontal lobe: Contralateral weakness, motor seizures, impaired cognition/higher-level functioning, changes in personality, impaired fluency of speech, dysphasiaParietal lobe: Contralateral cortical sensory deficit, impaired spatial relations, agnosia, apraxiaTemporal lobe: Visual field deficits, impaired memory, impaired speech and comprehension, impaired emotional responses, psychomotor seizuresOccipital lobe: Homonymous hemianopsia, visual hallucinations/seizuresCerebellum: Ipsilateral limb ataxia or truncal ataxia, nystagmusBrainstem: Cranial nerve deficits and long tract findingsGeneralized symptoms include headache, seizure, cognitive or behavioral change, fatigue, decreased responsiveness, lethargy, apathy, and confusion. Signs and symptoms related to elevated intracranial pressure include papilledema, headache, nausea, and vomiting (Wong and Wu, 2015). Headache is the most common initial presenting symptom of a brain tumor; however, only a very small percentage of patients with headaches end up harboring a tumor. Therefore, it is essential to elicit the specific features of the headaches. Brain tumors often present with headaches that are progressive over several months. Classically, the headache is worse in the morning, as intracranial vessels are dilated from hypoventilation during sleep, which further contributes to intracranial pressure. This feature is not found in every patient with a brain tumor, but if present, should raise suspicion for an intracranial lesion. Other features warranting further evaluation for brain tumor are the presence of headache associated with nausea and vomiting or a headache that worsens with changes in body position or maneuvers that increase intrathoracic pressure (Wong and Wu, 2015).
Practice Paper 2: Answers
Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar in Get ahead! Medicine, 2016
This woman is likely to have idiopathic intracranial hypertension (previously known as benign intracranial hypertension). Idiopathic intracranial hypertension is characterized by a raised intracranial pressure in the absence of space-occupying lesions, ventricular dilatation or impaired consciousness. The aetiology is unknown but it usually occurs in younger, obese women and can be precipitated by drugs (contraceptive pill, tetracyclines or steroid withdrawal). Features include a history of intermittent headaches, transient diplopia and blurring, and papilloedema. The CT scan is normal and a lumbar puncture may confirm a raised opening pressure. Management options include weight loss, removal of offending triggers, acetazolamide (a carbonic anhydrase inhibitor that decreases production of cerebrospinal fluid) and repeated lumbar puncture. If untreated, idiopathic intracranial hypertension can lead to blindness.
Do Optic Canal Dimensions Measured on CT Influence the Degree of Papilloedema and Visual Dysfunction in Idiopathic Intracranial Hypertension?
Published in Neuro-Ophthalmology, 2019
Nicholas T. Skipper, Mark S. Igra, Revelle Littlewood, Paul Armitage, Peter J. Laud, Susan P. Mollan, Basil Sharrack, Irene M. Pepper, Ruth Batty, Daniel J. A. Connolly, Simon J. Hickman
A recent study found that increased optic canal area on magnetic resonance imaging was associated with worse papilloedema in idiopathic intracranial hypertension (IIH). We repeated this study using more accurate computerized tomography derived measurements. Optic canal dimensions were measured from 42 IIH patients and 24 controls. These were compared with papilloedema grade. There was no correlation between any of the optic canal measurements and papilloedema grade and no significant difference in optic canal measurements between patients and controls. Our results cast doubt on the existing literature regarding the association between optic canal size and the degree of papilloedema in IIH. CT delineates bony anatomy more accurately than MRI and our CT-derived optic canal measurements cast doubt on the existing literature regarding the association between optic canal size and the degree of Papilloedema in IIH.
Ganglion Cell Complex Analysis as a Potential Indicator of Early Neuronal Loss in Idiopathic Intracranial Hypertension
Published in Neuro-Ophthalmology, 2019
Geetha Athappilly, Ignacio García-Basterra, Flavia Machado-Miller, Thomas R. Hedges, Carlos Mendoza-Santiesteban, Laurel Vuong
Reliable visual field testing is the gold standard in identifying future vision loss in patients with Idiopathic Intracranial hypertension (IIH). However, when field performance is unreliable, GCC analysis may be useful. We evaluated IIH patients over three visits: initial visit, follow-up visit and a third visit, almost 1 year later. We evaluated mean deviation (MD), GCC and RNFL at presentation and the second visit and compared it to the mean deviation (MD) on fields at the third visit. As early as the second visit, GCC loss correlated with visual field results seen at the third visit.
Idiopathic Intracranial Hypertension in a Mother and Pre-pubertal Twins
Published in Neuro-Ophthalmology, 2019
Shanlee M. Stevens, Collin M. McClelland, John J. Chen, Michael S. Lee
Idiopathic intracranial hypertension is a syndrome of elevated intracranial pressure without an identifiable cause. The majority of cases appear to be sporadic, and incidence is highest in obese women of childbearing age. The role of genetics in the pathophysiology of the disease is unclear, and familial cases are rare. We report a familial occurrence in a mother and her twin, 5-year-old sons.