Intracranial Hypertension, also known as IH, is caused by an increase in intracranial volume which raises intracranial pressure (ICP). IH can be caused by trauma such as epidural or subdural hemorrhages, or non-trauma etiologies including tumors, infections, inflammation, increased venous pressure, or brain edema. Symptoms include headache, vomiting, altered mental status, and papilledema visible on exam. Left untreated, IH can progress to brain herniation, with signs of irregular breathing, abnormal posture, and loss of consciousness. Diagnosis involves clinical assessment of symptoms and signs as well as imaging tests. Treatment focuses on reducing ICP through positioning,

1. Intracranial Hypertension
Subgroup 1

2. CONTENT
1. Definition
2. Pathophysiology
3. Etiology
4. Symptoms and Signs
5. Progress
6. Diagnosis
7. Treatment
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3. 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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4. II - PATHOPHYSIOLOGY
• Intracranial constituents:
– Brain and meninges
– CSF
– Blood supply (arteries and veins)
• Change in constituents  IH
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5. II - PATHOPHYSIOLOGY
• Brain and meninges:
– Dura mater
– Arachnoid mater
– Pia mater
– Brain parenchyma
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6. II - PATHOPHYSIOLOGY
• CSF Circulation:
– Site of production:
Choroid plexus
– Ventricles
– Subarachnoid space
– Optic foramen
– Site of absorption: Dural
sinus
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7. II - PATHOPHYSIOLOGY
• Arteries:
– Blood supply pressure: CPP
– CPP = MAP – ICP
• Vein: dural sinus (sagittal sinus)
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8. II - PATHOPHYSIOLOGY
↑ICP
CPP = MAP - ICP
↓CPP
↑BP
Brain ischemia Cerebral
Cerebral blood hemorrhage
vessels dilate
Brain edema
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9. III - ETIOLOGY
• Benign intracranial hypertension
• Trauma:
– Epidural hemorrhage
– Subdural hemorrhage
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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 …)
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11. IV - SYMPTOMS & SIGNS
• Symptoms:
– Headache: generalized, positional
– Vomiting: sudden, positional
– Altered mental status
– Back pain
– Abdominal pain
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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)
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13. V - PROGRESS
• Brain herniation
– Supratentorial
• Uncal (1)
• Central (2)
• Cingulate (3)
• Transcalvarial (4)
– Infratentorial
• Upward (5)
• Tonsillar (6)
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14. 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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15. VI - DIAGNOSIS
• Clinical: Signs and Symptoms
• Lab tests: MRI, CT reveal causes
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16. 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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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
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18. THE END
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