Your SlideShare is downloading. ×
0
Intracranial pressure abnormalities 05
Intracranial pressure abnormalities 05
Intracranial pressure abnormalities 05
Intracranial pressure abnormalities 05
Intracranial pressure abnormalities 05
Intracranial pressure abnormalities 05
Intracranial pressure abnormalities 05
Intracranial pressure abnormalities 05
Intracranial pressure abnormalities 05
Intracranial pressure abnormalities 05
Intracranial pressure abnormalities 05
Intracranial pressure abnormalities 05
Intracranial pressure abnormalities 05
Intracranial pressure abnormalities 05
Intracranial pressure abnormalities 05
Intracranial pressure abnormalities 05
Intracranial pressure abnormalities 05
Intracranial pressure abnormalities 05
Intracranial pressure abnormalities 05
Intracranial pressure abnormalities 05
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Intracranial pressure abnormalities 05

1,455

Published on

0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,455
On Slideshare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
89
Comments
0
Likes
1
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. INTRACRANIAL PRESSURE ABNORMALITIES www.freelivedoctor.com
  • 2. Intracranial hypertension <ul><li>Most oftenly associated with: </li></ul><ul><li>1) Rapidly expanding mass lesion </li></ul><ul><li>2) CSF outflow obstruction </li></ul><ul><li>3) Cerebral venous congestion </li></ul><ul><li>>250 mm CSF : manifestation of serious neurlogic disease </li></ul><ul><li>Lumbar CSF pressure may not accurately reflect intracranial pressure (ICP) </li></ul>www.freelivedoctor.com
  • 3. Signs of increase ICP <ul><li>Headache </li></ul><ul><li>Papilledema : most reliable sign of ICP </li></ul><ul><li>If ICP approaches the systolic blood pressure, the cerebral perfusion pressure decreases and irreversible ischemia may develop </li></ul>www.freelivedoctor.com
  • 4. Idiopathic intracranial hypertension <ul><li>A syndrome of increased ICP accompanied by: </li></ul><ul><li>No localizing neurologic signs </li></ul><ul><li>No intracranial mass lesion </li></ul><ul><li>No CSF outflow obstruction </li></ul><ul><li>An alert, otherwise healthy-looking patient </li></ul><ul><li>Almost always obese, oftenly female </li></ul><ul><li>Can be associated with a variety of systemic and iatrogenic disorders </li></ul><ul><li>Unknown cause </li></ul>www.freelivedoctor.com
  • 5. Pathophysiology of idiopathic intracranial hypertension <ul><li>Etiology is unknown, but is speculated as: </li></ul><ul><li>1) increase in dural sinus venous pressure </li></ul><ul><li>2) increase in CSF outflow resistance </li></ul><ul><li>3) increased CSF formation rate </li></ul><ul><li>4) some combination of the above </li></ul><ul><li>The constancy of obesity has sugested the possibility of hypothalamic disorder </li></ul>www.freelivedoctor.com
  • 6. Clinical manifestation of idiopathic intracranial hypertension <ul><li>Headache-most common </li></ul><ul><li>Bilateral papilledema-almost always present </li></ul><ul><li>Nausea/vomiting </li></ul><ul><li>Visual disturbance </li></ul><ul><li>Retro-ocular pain </li></ul><ul><li>Diplopia </li></ul><ul><li>Tinnitus </li></ul><ul><li>vertigo </li></ul>www.freelivedoctor.com
  • 7. “ Empty sella syndrome” <ul><li>In Chronically increased ICP </li></ul><ul><li>1) radographically globular enlargement of the sellar turcica </li></ul><ul><li>2) incompetent diaphragma sellae </li></ul><ul><li>3) Compressed, but functioning pituitary gland </li></ul>www.freelivedoctor.com
  • 8. Tx of idiopathic intracranial hypertension <ul><li>Four (4) general approaches: </li></ul><ul><li>1.-repeated lumbar puncture </li></ul><ul><li>2.-Pharmacologic treatment </li></ul><ul><li>3.-Shunting (Ventriculosystemic or lumbo-peritoneal) </li></ul><ul><li>4.-incision of optic nerve sheath </li></ul>www.freelivedoctor.com
  • 9. Hydrocephalus <ul><li>Net accumulation of CSF within the cerebral ventricles and their consequent elargement </li></ul><ul><li>CSF pressure is frequently normal (or low) in chronic hydrocephalus </li></ul>www.freelivedoctor.com
  • 10. Hydrocephalus classification <ul><li>1.- Obstructive </li></ul><ul><li>A.-non- communicating: </li></ul><ul><li>Caused by lesions obstructing intracerebral CSF circulation at or proximal to foramina of Luschka and Magendie. </li></ul><ul><li>B.-Communicating: </li></ul><ul><li>Caused by obstruction of basal cisterns or convexity subarachnoid space with ventricular system communicating with spinal subarachnoid space, but CSF cannot drain through arachnoid villi into superior sagital sinus </li></ul><ul><li>2.- Non-obstructive </li></ul>www.freelivedoctor.com
  • 11. Hydrocephalus acute vs. chronic <ul><li>Complete ventricular outflow obstruction </li></ul><ul><ul><li>Acute hydrocephalus </li></ul></ul><ul><ul><li>Coma </li></ul></ul><ul><ul><li>(death) </li></ul></ul><ul><li>Aqueductal stenosis </li></ul><ul><ul><ul><li>Complications of subarachnoid hemorrhage </li></ul></ul></ul><ul><ul><ul><li>Chronic hydrocephalus </li></ul></ul></ul>www.freelivedoctor.com
  • 12. Chronic hydrocephalus <ul><li>In many instances, the cause of symptomatic chronic hydrocephalus cannot be determined. </li></ul><ul><li>(“Normal pressure hydrocephalus”) </li></ul>www.freelivedoctor.com
  • 13. Clinical manifestations of hydrocephalus <ul><li>Acute obstructive hydrocephalus </li></ul><ul><ul><li>Severe headache </li></ul></ul><ul><ul><li>Lethargy </li></ul></ul><ul><ul><li>Signs of increased ICP </li></ul></ul><ul><ul><li>Papilledema </li></ul></ul><ul><ul><li>Abducens palsy </li></ul></ul><ul><ul><li>Signs of causative lesion </li></ul></ul><ul><ul><li>Hypereactive reflexes </li></ul></ul><ul><ul><li>Bilateral extensor planter responses </li></ul></ul>www.freelivedoctor.com
  • 14. Clinical manifestation of hydrocephalus <ul><li>Chronic communicating hydrocephalus </li></ul><ul><ul><li>Progressive dementia </li></ul></ul><ul><ul><li>Unsteady gait </li></ul></ul><ul><ul><li>Urinary incotinence </li></ul></ul><ul><ul><li>Bilateral pyramidal and extrapyramidal signs </li></ul></ul>www.freelivedoctor.com
  • 15. Tx of hydrocephalus <ul><li>Acute hydrocephalus: </li></ul><ul><li>Ventricular drainage and CSF diversion </li></ul>www.freelivedoctor.com
  • 16. Intracranial hypotension <ul><li>Low or zero lumbar CSF pressure (nl:70-200 mm CSF ; 5-15 mm Hg) </li></ul>www.freelivedoctor.com
  • 17. Intracranial hypotension <ul><li>CSF fìstula </li></ul><ul><li>Post-Lumbar puncture drainage </li></ul><ul><li>Spontaneus-idiopathic, dural nerve sheath tear. </li></ul><ul><li>Sever throbbing fronta and occipital headache </li></ul><ul><ul><li>Within 30 sec. After changing posture to erect </li></ul></ul><ul><ul><li>Subsides completely when lying flat </li></ul></ul><ul><ul><li>(dizzines, nausea, stiff neck, Photophobia) </li></ul></ul>www.freelivedoctor.com
  • 18. Intracranial hypotension <ul><li>Spontaneous intracranial hypotension is rare. </li></ul><ul><ul><li>Unknown etiology </li></ul></ul><ul><ul><li>Spontaneous recovery in days to a few weeks. </li></ul></ul>www.freelivedoctor.com
  • 19. Tx of intracrania hypotension <ul><li>Epidural “blood patch” </li></ul><ul><li>Injection of 10 ml of patient`s own blood into the epidural space </li></ul>www.freelivedoctor.com
  • 20. www.freelivedoctor.com

×