Intracranial Hypertension

Subgroup 1

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CONTENT

1. Definition2. Pathophysiology3. Etiology4. Symptoms and Signs5. Progress6. Diagnosis7. Treatment

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I - DEFINITION

• Skull: fixed compartment• Brain, blood and CSF: volume balance ICP• ICP: 7-15 mmHg (supine); -10 mmHg (vertical)• ↑volume ↑ICP (IH)

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II - PATHOPHYSIOLOGY

• Intracranial constituents:– Brain and meninges– CSF– Blood supply (arteries and veins)

• Change in constituents IH

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II - PATHOPHYSIOLOGY

• Brain and meninges:– Dura mater– Arachnoid mater– Pia mater– Brain parenchyma

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II - PATHOPHYSIOLOGY

• CSF Circulation:– Site of production:

Choroid plexus– Ventricles– Subarachnoid space– Optic foramen– Site of absorption: Dural

sinus

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II - PATHOPHYSIOLOGY

• Arteries:– Blood supply pressure: CPP– CPP = MAP – ICP

• Vein: dural sinus (sagittal sinus)

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II - PATHOPHYSIOLOGY

↑ICP

CPP = MAP - ICP

↓CPP↑BP

Cerebral blood vessels dilate

Cerebral hemorrhage

Brain ischemia

Brain edema

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III - ETIOLOGY

• Benign intracranial hypertension• Trauma:– Epidural hemorrhage– Subdural hemorrhage

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III - ETIOLOGY

• Non-trauma:– Tumor: mass + CSF production– Abscess, hematoma– Inflammation: CSF production– ↑ venous pressure (CHF, occlusion)– CSF flow obstruction– Brain edema (hepatoencelopathy, anoxia …)

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IV - SYMPTOMS & SIGNS

• Symptoms:– Headache: generalized, positional– Vomiting: sudden, positional– Altered mental status– Back pain– Abdominal pain

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IV - SYMPTOMS & SIGNS

• Signs: mass effect– Papilledema– Pupillary dilatation– CN VI palsy– Nuchal rigidity (neck stiffness): not painful– Cushing’s triad: ↑pulse pressure, ↓HR, irregular

respiration (Cheyne-Stokes, hyperventilation)

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V - PROGRESS

• Brain herniation– Supratentorial

• Uncal (1)• Central (2)• Cingulate (3)• Transcalvarial (4)

– Infratentorial• Upward (5)• Tonsillar (6)

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V - PROGRESS

• Signs and symptoms:– Vomiting– Irregular respirations– Abnormal posture– Low level of consciousness– Pupillary dilatation, response to light (-)– CN palsies

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VI - DIAGNOSIS

• Clinical: Signs and Symptoms• Lab tests: MRI, CT reveal causes

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VII - TREATMENT

• IH treatment:– Patient: lying, head motion restriction– Adequate airway, breathing & oxygenation– Anti-edema: mannitol, corticoid …

• Etiological treatment:– Drainage– Craniotomy

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REFERENCES

• http://en.wikipedia.org/wiki/Intracranial_pressure

• http://en.wikipedia.org/wiki/Brain_herniation• Trieu chung hoc Co so, tap 1 – NXB Y hoc

THE END

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