Increased Intracranial Pressure

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A very brief summary about intracranial hypertension (increased ICP)

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Increased Intracranial Pressure

  1. 1. Intracranial Hypertension Subgroup 1
  2. 2. CONTENT1. Definition2. Pathophysiology3. Etiology4. Symptoms and Signs5. Progress6. Diagnosis7. Treatment 2
  3. 3. I - DEFINITION• Skull: fixed compartment• Brain, blood and CSF: volume balance  ICP• ICP: 7-15 mmHg (supine); -10 mmHg (vertical)• ↑volume  ↑ICP (IH) 3
  4. 4. II - PATHOPHYSIOLOGY• Intracranial constituents: – Brain and meninges – CSF – Blood supply (arteries and veins)• Change in constituents  IH 4
  5. 5. II - PATHOPHYSIOLOGY• Brain and meninges: – Dura mater – Arachnoid mater – Pia mater – Brain parenchyma 5
  6. 6. II - PATHOPHYSIOLOGY• CSF Circulation: – Site of production: Choroid plexus – Ventricles – Subarachnoid space – Optic foramen – Site of absorption: Dural sinus 6
  7. 7. II - PATHOPHYSIOLOGY• Arteries: – Blood supply pressure: CPP – CPP = MAP – ICP• Vein: dural sinus (sagittal sinus) 7
  8. 8. II - PATHOPHYSIOLOGY ↑ICPCPP = MAP - ICP ↓CPP ↑BPBrain ischemia Cerebral Cerebral blood hemorrhage vessels dilate Brain edema 8
  9. 9. III - ETIOLOGY• Benign intracranial hypertension• Trauma: – Epidural hemorrhage – Subdural hemorrhage 9
  10. 10. III - ETIOLOGY• Non-trauma: – Tumor: mass + CSF production – Abscess, hematoma – Inflammation: CSF production – ↑ venous pressure (CHF, occlusion) – CSF flow obstruction – Brain edema (hepatoencelopathy, anoxia …) 10
  11. 11. IV - SYMPTOMS & SIGNS• Symptoms: – Headache: generalized, positional – Vomiting: sudden, positional – Altered mental status – Back pain – Abdominal pain 11
  12. 12. 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) 12
  13. 13. V - PROGRESS• Brain herniation – Supratentorial • Uncal (1) • Central (2) • Cingulate (3) • Transcalvarial (4) – Infratentorial • Upward (5) • Tonsillar (6) 13
  14. 14. V - PROGRESS• Signs and symptoms: – Vomiting – Irregular respirations – Abnormal posture – Low level of consciousness – Pupillary dilatation, response to light (-) – CN palsies 14
  15. 15. VI - DIAGNOSIS• Clinical: Signs and Symptoms• Lab tests: MRI, CT reveal causes 15
  16. 16. VII - TREATMENT• IH treatment: – Patient: lying, head motion restriction – Adequate airway, breathing & oxygenation – Anti-edema: mannitol, corticoid …• Etiological treatment: – Drainage – Craniotomy 16
  17. 17. REFERENCES• http://en.wikipedia.org/wiki/Intracranial_pres sure• http://en.wikipedia.org/wiki/Brain_herniation• Trieu chung hoc Co so, tap 1 – NXB Y hoc 17
  18. 18. THE ENDThank you for listening!
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