WHAT IS A STROKE/ ICP MONITORING


What is a stroke?
A stroke is also known as a brain attack.

Identifying strokes
A stroke may be hemorrhagic (caused by bleeding) or ischemic (embolic) caused by a clot or plaque
in a blood vessel. Bleeding into the brain may be caused by trauma or rupture of a blood vessel due  to high blood pressure. 

In the case of an embolic stroke, a blood clot may obstruct the flow of blood in the brain. This will also affect oxygen to the brain. Embolic strokes are usually treated with drugs such as TPA ( Tissue Plasminogenic Activator). Antihypertensive drugs and anti seizure medications may also be ordered.

How is a stroke diagnosed?
Signs and symptoms such as weakness on one side, speech difficulty, visual disturbances or aphasia help in making a diagnosis. A CAT scan or MRI are diagnostics tests done to confirm the diagnosis. 
Learn more :After a stroke
Can a stroke be prevented?




Why is ICP Monitoring done?
ICP ( Intracranial Pressure Monitoring) may be done for a number of reasons.These
include: hydrocephalus, Subarachnoid  hemorrhage, severe head injury, hepatic encephalopathy.
Intracranial Pressure (ICP) Monitoring is done to monitor and treat increased brain pressure.
If the brain pressure is high, the doctor will order treatment to decrease brain swelling.
Depending on the degree of swelling in the brain, surgical intervention, or an EVD may
be placed. 

An EVD ( external ventricular device ) is placed in the ventricle inside the brain.This is done
by the doctor, under sterile conditions. This will allow drainage of cerebrospinal fluid ( CSF) or 
blood to be drained and decrease brain swelling. Medications such as Mannitol is also used.
Pain medication and sedation is also ordered.

Brain herniation
Herniation may very readily occur if brain swelling is left untreated. Swelling in the brain
may cause brain tissue to exit through the Foramen Magnum at the base of the skull.Medical
or surgical intervention is usually done, to maintain normal ICP and prevent herniation.

How is ICP managed?
Typically, ICP monitoring is done in an ICU setting.
The doctor orders vital signs, frequency of ICP recordings, pain, and other medications. The nurse has an important role in assessing and documenting the patient's neurological status, vital signs,  oxygen saturation, intake, and output.S ignificant changes of any kind should be reported to the doctor. The brain injured patient, benefits from adequate rest, as this helps to prevent secondary injury to the brain.
Cranial nerves

In the image below, an EVD ( External Ventricular Device) is being inserted.
How is insertion of an EVD done?
Under sterile conditions, the neurosurgeon shaves an area of the head and cleanses the skin. A device similar to a wall drill is used to penetrate the skull and access the ventricle. A sterile catheter is placed in the ventricle and a drainage system is attached.
Enjoy watching the video for more information 
The New Nurse- ICP Monitoring


                                                         Meningeal coverings and ventricles of the brain

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