Increased Intracranial Pressure
Posted by Healthfitline
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Saturday, October 6, 2012
Increased Intracranial Pressures is a condition where the pressure inside the brain is increased. It occurs as a result of a head injury, brain tumor, brain hemorrhage or due to increased celebral spinal fluid formation or problem with CSF outflow. Some of the conditions that affect CSF outflow are such as; hydrocephalus and brain viral infections. Intracranial pressure is measured in lateral ventricles with normal ranging from 5 to 15mmHg or 60-180cm of H20.
Pressure inside the brain is controlled and maintained by three things; brain tissues, blood volume and CSF (celebral spinal fluid). The brain has a limited space to expand and whenever there is changes in any of the three components, it causes a change in volume of the other two. These three components work together to maintain intracranial pressure at the required level.
Typically, what happens when there is an increased intracranial pressure is that, the brain compensate by either decreasing the celebral blood volume, decreasing or increasing the production of CSF or displacing or shifting the CSF. If these changes do not happen, intracranial pressure begins to rise.
In normal circumstances, we all do experience slight changes in CSF and blood volume during those activities that interfere with the intrathoracic pressure such as; when sneezing, coughing, posture, change in blood pressure or positions, among others.
Symptoms of Increased Intracranial Pressure
The symptoms experienced by an individual depends on how high the pressure is inside the brain. In normal circumstances, the brain is able to adjust well without any symptoms but once the pressure significantly increases, the brain can no longer compensate as required. The first sign that you may notice is the alteration in level of consciousness such as; restlessness, confusion.
At this stage, intensive intervention is required since further increase in intracranial pressure may lead to what we call the cushing triad, manifested by the following signs and symptoms; increase in body temperature, respiratory irregularities, widening pulse pressure (increasing difference between dystolic and systolic pressure), irritability, nausea, headache and vomiting.
Further increase in intracranial pressure leads to more damage. The patient may become stupurous (reacting to painful or loud stimuli only). This is a critical sign since it signifies the condition of the patient is worsening. At this stage, there is the possibilities that the brain may be undergoing significant irreversible damage.
As the pressure increases further, neural function is completely impaired. The patient may become comatose and may start exhibiting abnormal motor responses known as; decortication and decerebration. Decortication is the flexion of the upper extremities and extension of the lower extremities. Decerebration is the extension of the upper and lower extremities or flaccidity. At this stage, death is usually inevitable.
Increased Intracranial Pressure Complications
One of the major complication of increased intracranial pressure is herniation; the displacement of brain tissues acrosss the tentorium, foramen magnum (opening) into the spinal cord. This occurs due to excessive increase in intracranial presure which causes more swellings and building up of pressure in the cranial vault, pressing the brain tissue downwards towards the brain stem.
The displaced brain stem can no longer receive the needed blood volume to maintain a constant blood flow to the brain leading to brain anoxia (lack of oxygen in the brain) and eventually brain death.
Treatment for Intracranial Pressure
Increased intracranial pressure is a serious emergency condition and prompt medical attention is required to prevent further complications. One way of managing increased intracranial pressure is through constant monitoring of the patient. The other ways that increased intracranial pressure is treated or managed is by;
- Decreasing the cerebral edema - patient may be given steroids.
- Lowering CSF or decreasing blood volume - Osmotic diuretics are recommended to remove the fluid from the brain.
- Fluid Restriction
- Surgery to drain CSF
- Controlling fever with antipyretics medications.
- Maintaining of desirable systematic blood pressure.
- Proper positioning of the patient.
- Reduction of cellular metabolic demands.
- Oxygenation
Finally, increased intracranial pressure is an emergency and serious condition and prompt seeking of medical attention is required to enable the medical care personnel to identify and correct the cause of the increasing intracranial pressure early in course before leading to complications.
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