NUR 252- Exam 4- Intracranial
Regulation Review Questions and
Correct Answers
Intracranial regulation definition ✅maintaining a balance to promote an environment
that is conducive to optimal brain functioning
Three components in skull ✅brain 80%
Blood 10%
Csf 10%
Icp (intracranial pressure) ✅the sum of pressure exerted by these three elements.
Normally it is below 15 mm hg
What is considered an increased intracranial pressure/intracranial hypertension?
✅sustained greater than 20 mm hg
Monro-kellie doctrine ✅if one component increases, another must decrease to
maintain icp
Herniation ✅displacement of brain tissue into other compartments of the brain (leads
to cell death and lack of blood flow, o2 to the brain)
What does herniation increase ✅ischemia and edema
What is fatal about herniation ✅compression of brainstem and cranial nerves,
respiratory arrest will occur due to compression of the respiratory control center in the
medulla
What is the first sign we see in patients with brain injuries that tells their symptoms are
worsening? ✅mental status changes
What kind of breathing is seen in someone who had a brain injury? ✅cheyne-stokes
breathing: rapid breathing then stop breathing
Increased icp clinical manifestations ✅- level of consciousness
- cheyne-stokes ataxic breathing
- papilledema can occur, edema and inflammation of optic nerve
- compression of cranial nerve and ocular nerve resulting in abnormal movement of
pupils
- motor responses can vary
, Autoregulation ✅adjusts regional cerebral blow flow (cbf) in response to metabolic
demands by changing diameter of cerebal blood vessels
Cerebral perfusion pressure ✅calculated by subtracting icp from map. When cpp is
less than 60 mm hg, cerebral blood flow is compromised and autoregulation is impaired
Blood-brain barrier ✅specialized endothelial cells; selective entry of substances in the
brain
What is injured brain tissue susceptible to? ✅cytotoxic edema which occurs due to
swelling of ischemic tissue
Vasogenic edema ✅fluid can accumulate into interstitial space
Primary injury ✅occurs at the moment of impact as a direct result of mechanical injury
Ex) primary injuries ✅fractures, hematomas, contusions, lacerations, concussions,
shearing and hemorrhage
Secondary injury ✅the biochemical and cellular response to the initial trauma that can
exacerbate the primary injury
Ex) secondary injury ✅ischemia, neuronal death, cerebral swelling, inflammation
Skull fractures ✅common, but do not act alone to cause neuro deficits, can be
classified as open or closed or as fractures of the vault or the base
What does a skull fracture increase the risk for? ✅intracranial hematoma
Basilar skull fracture ✅major complications are cranial nerve injury and csf leak
Manifestations of basilar skull fracture ✅- csf leaking from ear (otorrhea) or nose
(rhinorrhea)
- battle's sign
- raccoon eyes
- halo sign
Battle's sign ✅ecchymosis or bruising behind the ear
Raccoon eyes ✅periorbital edema and bruising
Halo sign ✅drainage from ear/nose put on a white 4x4 blood will congeal in middle, if
yellow ring around it, csf present
Regulation Review Questions and
Correct Answers
Intracranial regulation definition ✅maintaining a balance to promote an environment
that is conducive to optimal brain functioning
Three components in skull ✅brain 80%
Blood 10%
Csf 10%
Icp (intracranial pressure) ✅the sum of pressure exerted by these three elements.
Normally it is below 15 mm hg
What is considered an increased intracranial pressure/intracranial hypertension?
✅sustained greater than 20 mm hg
Monro-kellie doctrine ✅if one component increases, another must decrease to
maintain icp
Herniation ✅displacement of brain tissue into other compartments of the brain (leads
to cell death and lack of blood flow, o2 to the brain)
What does herniation increase ✅ischemia and edema
What is fatal about herniation ✅compression of brainstem and cranial nerves,
respiratory arrest will occur due to compression of the respiratory control center in the
medulla
What is the first sign we see in patients with brain injuries that tells their symptoms are
worsening? ✅mental status changes
What kind of breathing is seen in someone who had a brain injury? ✅cheyne-stokes
breathing: rapid breathing then stop breathing
Increased icp clinical manifestations ✅- level of consciousness
- cheyne-stokes ataxic breathing
- papilledema can occur, edema and inflammation of optic nerve
- compression of cranial nerve and ocular nerve resulting in abnormal movement of
pupils
- motor responses can vary
, Autoregulation ✅adjusts regional cerebral blow flow (cbf) in response to metabolic
demands by changing diameter of cerebal blood vessels
Cerebral perfusion pressure ✅calculated by subtracting icp from map. When cpp is
less than 60 mm hg, cerebral blood flow is compromised and autoregulation is impaired
Blood-brain barrier ✅specialized endothelial cells; selective entry of substances in the
brain
What is injured brain tissue susceptible to? ✅cytotoxic edema which occurs due to
swelling of ischemic tissue
Vasogenic edema ✅fluid can accumulate into interstitial space
Primary injury ✅occurs at the moment of impact as a direct result of mechanical injury
Ex) primary injuries ✅fractures, hematomas, contusions, lacerations, concussions,
shearing and hemorrhage
Secondary injury ✅the biochemical and cellular response to the initial trauma that can
exacerbate the primary injury
Ex) secondary injury ✅ischemia, neuronal death, cerebral swelling, inflammation
Skull fractures ✅common, but do not act alone to cause neuro deficits, can be
classified as open or closed or as fractures of the vault or the base
What does a skull fracture increase the risk for? ✅intracranial hematoma
Basilar skull fracture ✅major complications are cranial nerve injury and csf leak
Manifestations of basilar skull fracture ✅- csf leaking from ear (otorrhea) or nose
(rhinorrhea)
- battle's sign
- raccoon eyes
- halo sign
Battle's sign ✅ecchymosis or bruising behind the ear
Raccoon eyes ✅periorbital edema and bruising
Halo sign ✅drainage from ear/nose put on a white 4x4 blood will congeal in middle, if
yellow ring around it, csf present
