Increased Intracranial Pressure
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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
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THE END
Thank you for listening!