Causes and treatment of intracranial pressure

1 Characteristics of intracranial hypertension

Intracranial hypertension, also called intracranial hypertension, cerebral edema and increased intracranial pressure, is a condition involving an abnormal increase in the pressure of the cerebrospinal fluid.

2 Etiology of the disease

Intracranial hypertension occurs suddenly. Thanks to timely intervention, you can avoid irreversible brain damage or death.

The main causes of increased head pressure are:

• brain tumors, including hematomas, abscesses;
• hydrocephalus or an excessive amount of production of cerebrospinal fluid;
• cerebral edema as a result of a trauma or brain tumor, a neuroinfection such as meningitis;
• congenital malformations of the skull, genetic syndromes.

3 Cushing's triad

A gradual increase in intracranial pressure is associated with nonspecific and less pronounced symptoms. They may manifest difficulty in learning, drowsiness, headache, nausea, vomiting, blurred vision. Headaches are usually stronger during activities that affect the increase in intracranial pressure, such as coughing, sneezing, significant physical exertion. The pain can be pulsating and blunt and cover the entire head.

When the acute manifestation of such a disease as intracranial pressure, the symptoms are almost the same, but with a more pronounced character. Nevertheless, their dynamics may be unpredictable.

Symptoms of acute manifestation of intracranial hypertension are as follows:

• headache;
• blurred vision;
• slowing of the heart rate, known as a bradycardia;
• increased blood pressure;
• nausea and vomiting;
• stiff neck;
• nerve palsy( which leads to a double vision when the patient looks "in the direction of injury");
• is an obvious change in behavior;
• convulsive attack, numbness, weakness;
• imbalance and consciousness, including excessive daytime drowsiness and coma.

4 Symptoms of the disease

The triad of Cushing is a complex of symptoms, indicative of increased intracranial pressure. Diseases in which the Cushing triad arises represent a direct threat to life and health( stroke, head hemorrhage).The main method of treating the triad of Cushing's are actions that will help reduce intracranial pressure and remove the cause of its increase.

The name comes from the name of Harvey Williams Cushing, who described the triad and Cushing's disease. The composition of the triad includes the following symptoms:

• arterial hypertension;
• bradycardia( slow heartbeat);
• breathing disorder( usually its acceleration).

As a result of the growth of intracranial pressure, the structures of the brain responsible for controlling pressure, speed of heartbeat and respiration are suppressed.

5 Factors of accumulation of cerebrospinal fluid

The human skull has a certain volume, an average of 1350 cubic meters.cm, which consists of the brain( 80%), blood and cerebrospinal fluid( 10%).This is a closed system, but it has some possibilities for compensating for changes in volume, but only by regulating the amount of blood flowing or the cerebrospinal fluid produced. When these two processes are impossible to implement, there is an increase in intracranial pressure, since the brain has virtually no chance of replacing its volume.

The causes of the Cushing's triad are as follows:

• excessive accumulation of cerebrospinal fluid;
• pathologies caused by the "mass effect";
• pathology in vessels;
• cerebral edema caused by other causes.

Excessive accumulation of cerebrospinal fluid can be associated with the following factors:

1. Hydrocephalus, which causes suppression of the skull space with liquid. Diseases that have a localization in the brain, most often cause increased pressure. This is meningitis, swelling, intraventricular hemorrhage.
2. Hyperproduction of cerebrospinal fluid caused by papillomas of the vascular plexus is a rare type of cancer originating from the cerebral vessels of the cerebral hemispheres. In half the cases it develops in the side chamber, which is the largest air chamber of the cerebral hemispheres. It affects children most often, and the way of treatment is an operation procedure performed by the child, with the purpose of removing the tumor.

The "mass effect" is an increase in brain volume or the appearance of a new structure that causes the displacement of other parts of the brain within the skull. The causes of this condition are the following disorders:

• tumor;
• hematoma( extradural or subdural);
• abscess;
• is an inflammation of the brain;
• massive stroke;
• edema.

More rarely, the characteristic causes of the mass effect are a foreign body in the skull( brain) or air.

Pathologies in the vessels include increasing blood pressure or blood volume within the cerebral hemispheres caused by a bleeding disorder( thrombosis of the sinuses of the brain) or its influx( increased blood flow to the brain).

Brain edema can be caused by the following reasons:

• by hyperosmolarity due to hyponatremia( decrease in the concentration of sodium in the blood);
• hydrocephalus;
• by vascular pathology, for example, abscess, trauma, bruise or tumor;
• toxins;
• almost every factor that can damage the brain.

6 Diagnosis and treatment measures

The causes of increased intracranial pressure should be quickly determined. Depending on them, appropriate treatment is implemented. First of all, the doctor must determine the signs of the disease for further diagnostic and therapeutic procedures. To study the disease, visualization methods such as computer and magnetic resonance imaging are used. In addition, high intracranial pressure should be measured, for example, during lumbar puncture or by a special catheter inserted into the ventricle of the brain.

Patient with a sudden increase in intracranial pressure should be hospitalized. It is recommended that he rest in a supine position with his head raised( at 30-45 degrees from the body level), which facilitates venous outflow from the brain.

It is important to monitor the fluid balance, and also to relieve pain and heat. It is necessary to maintain a proper rate of oxygenation of blood and tissues( norm РСО2 35-40 mmHg).

It is necessary to use drugs that reduce cerebral edema, such as mannitol, glucocorticosteroids, hypertensive saline solutions, furosemide and others, depending on the needs of the patient.

A patient who has been intubated can undergo mechanical ventilation. This treatment leads to spasm of the cerebral vessels, rapidly reducing the increased intracranial pressure. Barbiturate and neuromuscular blockade can help reduce ICP.If there are no contraindications, the patient may be subjected to hypothermia.

In most cases, the most effective treatment for high intracranial pressure is to eliminate the cause. Treatment is performed using the following methods:

• tumor removal, abscess, massive hematoma;
• partial removal of skull bone to reduce pressure in the head;
• therapy infection - inflammation of the meninges;
• equalization of metabolic disorders;
• is a kind of therapy against toxins.

Other methods of treatment of increased intracranial pressure, used, as a rule, regardless of the cause, are as follows:

• rise at the head about 20-30 °;
• treatment with analgesics;
• maintaining normal body temperature;
• optimized hyperventilation: involves the use of more aggressive hyperventilation with the measurement of jugular venous saturation to prevent induced ischemia;
• prevention, reduction of PaO2( partial pressure of oxygen);
• reception of glucocorticosteroids( steroids) - only with swelling associated with tumors and inflammatory diseases;
• administration of mannitol( osmotic diuretic) is used with increased intraocular pressure;
• administration of furosemide - better after mannitol to activate anti-edema action;
• short-term introduction of barbiturates( the use of barbiturates in the therapy of intracranial hypertension requires intensive monitoring and is associated with a significant risk of complications, especially hypotension, withdrawal of treatment should be gradual in order to avoid a sharp drop in pressure);
• control of fluid balance, constant monitoring: blood pressure, heart function, gases in the blood.

Hypothermia - cooling to 35 ° C - is effective in reducing intracranial hypertension and has fewer systemic complications.

If you do not take measures to normalize the pressure, the disease will take a chronic form. This is fraught with the emergence of many diseases, the most dangerous of which is a stroke. Therefore, it is better to take the problem seriously and treat it immediately after the diagnosis is confirmed.