Associated visual and/or neurological symptoms should be sought, including visual blurring, visual loss, disturbance of visual fields, or diplopia. 2,5Ī thorough history should include asking about the use of new medications or inadvertent ocular contact with foreign substances by rubbing the eyes.
2–4 Non-physiological anisocoria indicates disease of the sympathetic or parasympathetic pathways supplying the pupil, or a problem with the iris itself. Physiological anisocoria is common: approximately 20% of normal people have different-sized pupils. 1 This article aims to guide management in both of these situations. Indeed, new onset anisocoria may be an early sign of a life-threatening emergency. The general practitioner (GP) may discover anisocoria during examination for a seemingly unrelated problem. The aetiology may be physiological, pathological or pharmacological.
I’ve always had trouble remembering which was which. Here’s a few ways, tell me what works best for you!Ī. What are they? A picture’s worth a thousand words, and a video’s even better. Don’t try to follow everything he’s narrating, but focus on what these positions look like: Ģ. Decorticate (flexion positioning) -> progressing to -> Decerebrate (extension positioning)ġ.Alteration in level of consciousness (LOC).Vomiting (because ICP is putting pressure on the areas of the brain that control your autonomic nervous system).Headache (and it will be a BAD one…Tylenol won’t help this pain!).Variable signs of ICP (sometimes early, sometimes late, sometimes never!).Unilateral pupil dilation (one pupil is dilated, the other responds normally…for now).Changes in vision (increased blind spot, blurred vision).
#Icp unequal pupil size how to
Increased fluid in the brain. This is usually going to be due to an increase in CSF. One possible cause is the ventricles in the brain are blocked, and so excess CSF can’t move down into the spinal column (ever heard of a VP Shunt? This is why that do that…)Ĥ) Almost everyone knows that dilated and fixed pupils are a sign of ICP. This means that the pupils are big, and stay big even when you shine a light into them. But did you know that this is a very late sign of ICP? As a nurse, if you’re only noticing s/sx of ICP at that point, then either the ICP progressed very rapidly, or you’d better have some good malpractice insurance! Most test questions are going to want you to know how to catch ICP early. So what are some earlier signs of ICP that you should be assessing for?.Brain cell death. We’re not just talking 1 or 2 neurons here, but an area of cell death that might be caused by something like trauma or hypoxia (lack of oxygen). And whenever cells die, your body sends the clean-up crew (remember those white blood cells (WBCs)?), and they cause inflammation and swelling in the brain just like they would anywhere else in the body.Bleeding in the brain. Something happens that causes the blood-brain barrier to break down, and allows fluids such as blood to leave the capillaries and enter the brain space.3 types of Cerebral Edema (brain swelling).So…ICP is: An applied force inside the skull. In other words, there’s pressure on the brain. And that’s usually a bad thing.Ģ) What are the 3 things inside the skull that affect ICP?ģ) If one or more of those things increase and the body can’t compensate by reducing one of the others, then the ICP will increase. Identify some causes of ICP. It’s exactly what it sounds like, just think about what each word (or word part) in the name means.
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