What are some signs and symptoms of
hypertension and intracranial pressure space?
Headache, vomiting, papilledema,
and altered consciousness.
Remember, a patient who is experiencing
intracranial hypertension or high ICPs
may not be at all aware that
they have increased ICPs.
Furthermore, if the patient
is clinically deteriorating,
these signs may not be present and
yet the patient may have high ICPs.
I’d like to ask you a question.
What might alert you to
an impending herniation
of somebody who has
I’ll give you a second
to think about this.
Cushing’s Triad is a classic triad that I
would encourage you to commit to memory.
These signs demonstrate that the
patient may be impending herniation.
They include high
the Cushing’s reflex,
and abnormal breathing.
I would like to introduce
you to a very important
concept called the
Speaking of the patient that
has intracranial hypertension,
what does that cause herniation?
Well, the skull is actually a fixed space
and it contains brain, blood, and CSF.
Given in a fixed space as one of these
compartments increase in our situation,
the brain due to an intracranial mass or
bleed, the other compartments have to give.
This fixed space
demonstrates to you
why as bleeding causes increase
mass effect on the brain
that the brain may want to herniate through
the foramen magnum near the brainstem.
This also explains why sometimes you
get unilateral fixed pupils because
one side of the brainstem may be
herniating prior to the other.
It’s incredibly high-yield
important to understand
the mechanisms to treat
One of the first maneuvers we
try and may sound overly simple
but by simply elevating the head
of the bed past 30 degrees,
one can improve venous
return and decrease ICPs.
Next, you can transiently and try
hyperventilation by breathing CO2 down,
you induce a hypocapnic
This, however, has a limited effect and
has a downside of vasoconstriction,
thereby also reducing the amount
of oxygen delivered to the brain.
We also use osmotic whether
it’s hypertonic saline or
mannitol diuretics to decrease
Sedation or induction of
coma with phenobarbital
is another option for patients
who have worsening ICPs.
And although somewhat
with severe ICPS, we can
Some important clinical pearls and high-yield
information on traumatic brain injury.
Remember, review the different
as it is both clinically practical as
well as high yield on your examination.
And the Cushing’s reflex of
and abnormal breathing may be
suggestive of impending herniation
and rapid action is necessary.
Thank you very much for joining me on this
discussion of traumatic brain injuries.