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2 out of 5

All of the following are used to decrease intracranial pressure, Except: (AIIMS Nov 2011)

A Frusemide
B Mannitol

C Steroid
D Hyperventilation

Ans. A


Norma ICP= 0-10 mm Hg,

TYPES of raised ICP.

1). Vasogenic = capillary permeability (Tumor, trauma & infection)

2). Cytototic cell = death ( Ref. Hariypoxia)

3). Interstitial : Obstructive hydrocephalous

Sign / symptom – Headache, Hypertension, Bradycardia, Cheyne stoke breathing, pupil constrict initially then dilate later, papilledema alter sensorium.

['Early signs of elevated ICP include drowsiness and a diminished level of consciousness (altered mental status). Coma and unilateral pupillary dilation are late signs and require immediate intervention. ']

TABLE 258-2 Stepwise Approach to Treatment of Elevated Intracranial Pressure

(Ref. Hari-18th ed., Pg 2257, Table 275-2)

Insert ICP monitor—ventriculostomy versus parenchymal device

General goals: maintain ICP <20 mmHg and CPP >70 mmHg

For ICP >20–25 mmHg for >5 min:

1). Drain CSF via ventriculostomy (if in place)

2). Elevate head of the bed

3). Osmotherapy— mannitol is used (Extra Edge: Frusemide is not used)

4). Glucocorticoids—dexamethasone for vasogenic edema from tumor, abscess

5). Sedation (e.g., morphine, propofol, or midazolam); add neuromuscular paralysis if necessary

6). Hyperventilation—to PaCO2 30–35 mmHg

7). Pressor therapy—phenylephrine, dopamine, or norepinephrine to maintain adequate MAP to ensure CPP >70 mmHg

8). Consider second-tier therapies for refractory elevated ICP

a. High-dose barbiturate therapy (“pentobarb coma”)

b. Hemicraniectomy

Note: (CPP, cerebral perfusion pressure; MAP, mean arterial pressure; PaCO2, arterial partial pressure of carbon dioxide).