Neuro Knowledge Check
Increased Intracranial Pressure (ICP)
• Patho: ICP results from imbalance between brain tissue, blood, and CSF within the rigid
skull. Normal ICP = 0–10 mmHg; values >20 mmHg cause risk of ischemia and
herniation.
• Clinical Manifestations:
o Infants: Bulging fontanel, irritability, poor feeding, sunsetting eyes.
o Children: Headache, emesis, change in LOC, seizures, pupillary changes,
Cushing’s triad (late sign).
• Management:
o Priority Assessments: Neuro status with Pediatric GCS (eye, motor,
auditory/visual).
o Monitoring: LOC, pupillary reaction, vital signs, seizures, fluid balance, signs of
SIADH.
o Environment: Low-stimulation, head midline, avoid neck vein compression.
o Fluids: Strict monitoring; avoid hypotonic fluids.
o Contraindications: Lumbar puncture if ICP suspected (risk of herniation).
o Meds: Mannitol, hypertonic saline, anticonvulsants.
Seizures
• Patho: Abnormal excessive electrical discharges in the brain.
• Etiology: Fever (febrile), epilepsy, trauma, infection, metabolic or genetic causes.
• Manifestations: Classified as partial (simple/complex) or generalized (tonic-clonic,
absence, myoclonic, atonic).
• Diagnosis: History, seizure description, EEG, metabolic panel, neuroimaging.
• Management:
o Assessments: Maintain airway, monitor seizure activity (time, type), neuro status.
o Meds: Anticonvulsants (phenytoin, valproate, levetiracetam), rescue
benzodiazepines.
o Surgery: Resection, vagal nerve stimulator if refractory.
o Education: Seizure first aid, medication adherence, triggers, injury prevention.
Increased Intracranial Pressure (ICP)
• Patho: ICP results from imbalance between brain tissue, blood, and CSF within the rigid
skull. Normal ICP = 0–10 mmHg; values >20 mmHg cause risk of ischemia and
herniation.
• Clinical Manifestations:
o Infants: Bulging fontanel, irritability, poor feeding, sunsetting eyes.
o Children: Headache, emesis, change in LOC, seizures, pupillary changes,
Cushing’s triad (late sign).
• Management:
o Priority Assessments: Neuro status with Pediatric GCS (eye, motor,
auditory/visual).
o Monitoring: LOC, pupillary reaction, vital signs, seizures, fluid balance, signs of
SIADH.
o Environment: Low-stimulation, head midline, avoid neck vein compression.
o Fluids: Strict monitoring; avoid hypotonic fluids.
o Contraindications: Lumbar puncture if ICP suspected (risk of herniation).
o Meds: Mannitol, hypertonic saline, anticonvulsants.
Seizures
• Patho: Abnormal excessive electrical discharges in the brain.
• Etiology: Fever (febrile), epilepsy, trauma, infection, metabolic or genetic causes.
• Manifestations: Classified as partial (simple/complex) or generalized (tonic-clonic,
absence, myoclonic, atonic).
• Diagnosis: History, seizure description, EEG, metabolic panel, neuroimaging.
• Management:
o Assessments: Maintain airway, monitor seizure activity (time, type), neuro status.
o Meds: Anticonvulsants (phenytoin, valproate, levetiracetam), rescue
benzodiazepines.
o Surgery: Resection, vagal nerve stimulator if refractory.
o Education: Seizure first aid, medication adherence, triggers, injury prevention.
