INTRACRANIAL PRESSURE ABNORMALITIES 05.ppt

2,739 views

Published on

0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
2,739
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
135
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

INTRACRANIAL PRESSURE ABNORMALITIES 05.ppt

  1. 1. INTRACRANIAL PRESSURE ABNORMALITIES <ul><li>Enrique De La Mora Glasker M.D. </li></ul>
  2. 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>
  3. 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>
  4. 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>
  5. 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>
  6. 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>
  7. 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>
  8. 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>
  9. 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>
  10. 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>
  11. 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>
  12. 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>
  13. 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>
  14. 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>
  15. 15. Tx of hydrocephalus <ul><li>Acute hydrocephalus: </li></ul><ul><li>Ventricular drainage and CSF diversion </li></ul>
  16. 16. Intracranial hypotension <ul><li>Low or zero lumbar CSF pressure (nl:70-200 mm CSF ; 5-15 mm Hg) </li></ul>
  17. 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>
  18. 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>
  19. 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>

×