Early and Late

SUBMITTED BY:Rachel M. Raynog

BSNIII-A8

signs of Increased

Intracranial Pressure

EARLY• Deterioration in the level of

consciousness– Early signs are confusion, restlessness,

lethargy, and disorientation first to time, then to place, and then to person

• Pupillary dysfunction relative to size, shape, and reaction to light:– Early signs are a gradual dilation, a slightly

ovoid shape, and a sluggish response to light ipsilateral to the lesion

• Motor weakness and sensory deficits– Early signs are monoparesis, hemiparesis,

and decreased visual acuity, such as blurred vision, diplopia, and field cuts

EARLY• Headache

-Early signs are slight or vague headache which is the worst upon arising in the morning

• Blood pressure

-Relatively stable in early stages• Pulse

-Relatively stable in early stages• Temperature

- Within normal ranges during compensatory stage

LATE• Deterioration in the level of

consciousness– Later signs are stupor and coma

• Pupillary dysfunction relative to size, shape, and reaction to light:– Later signs are dilation of the ipsilateral

pupil and a non-reactivity to light– Final stage signs are bilateral dilation and

fixation• Motor weakness and sensory deficits– Later signs are hemiplegia, decortication, or

decerebration (either unilateral or bilateral) and triple flexion away from the source of stimuli

LATE• Cranial nerve paralysis• Possible seizures, possible

vomiting (including projective vomiting), and possible papilledema

• Respirations

-acute neurogenic pulmonary edema, adult respiratory distress syndrome, and disseminated intravascular coagulopathy can result from an acute increase in ICP.

LATE• Blood pressure

-Increased blood pressure and a widening pulse in later stages which signal cerebral dysfunction that may be irreversible

oCushing's response (a compensatory response that attempts to provide adequate CPP in the presence of rising ICP) presents as a rising systolic pressure, a widening pulse pressure, and bradycardia and is a late presentation of brain stem dysfunction

oCushing's triad (a very late presentation of brain stem dysfunction) presents as hypertension, usually with a widening pulse pressure, bradycardia, and abnormal respiratory patterns

LATE• Pulse

oIrregular, rapid, and thready in the decompensatory stage

• TemperatureoHigh temperatures can occur during decompensatory stage

• Impaired brain stem reflexes, such as corneal and gag reflexes

 

END