Intracranial Hypertension

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Intracranial Hypertension
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Aim
1 Learn Icp physiology,etiology and mechanism. 2
Know ICP?etiology ?pathology. 3 Know herniation
anatomy basis?reason?pathology? 4 Gasp ICP?clinic
manifestation,type and any kinds of
herniations clinic manifestation. 5 Gasp ICP?
and herniation clinic diagnosis,treatment.
??
2001?2???
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V/v of the brain

disease
brain 85b
blood 5
CSF 10
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intracranial pressure, ICP
Adult 0.7-2.0kPa (70-200mmH2O) Child 0.5-1.0kPa
(50-100mmH2O)
Effect elements
Blood pressure
breath
systole diastole
inpiration expiration
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ICP?
Conception
ICP continuous ?2.0 kPa (200 mmH2O)
Etiology
1) Normal component in intracranial 2) Mass and
intracranial volume?
(1) Intracranial mass (2) Volume of brain
increased (3) Disorder between absorption and
production in CSF (4) Intracranial capacity
reduced (5) Cerebral blood flow or vein pressure
continuous increased
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ICP? Effect elements
(1) Age (2) expand speed   (3) location (4)
the degree of brain edema (5) the whole condition
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Effect elements
(1) Age
Older Infant
compensatoty? course ?
70y
10m
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Effect elements
(2) Expand speed
pressure
B
A
volume
volume-pressure response VPR
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Effect elements
(3) location
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Effect elements
(3) Location
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Effect elements
(3) Location
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Effect elements
(3) Location
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Effect elements
( 4 )   the degree of brain edema
2000-5-26
2000-7-12
2000-12-5
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Effect elements
(4)the degree of brain edema
(5)whole condition
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ICP?
(1) Affect cerebral blood flow (2) Herniation of
brain (3) Brain edema (4) Function derangement in
stomatch and intestine (5) Lung edema (6)
Cushing responce
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Cerebral Blood Flow (CBF) Normal adult
CBF CBFs effect element
50 ml/100 gm of brain/min (750 ml/min)
Gray substance70-100 ml/100 gm of
brain/min White substance 20-25 ml/100 gm of
brain/min
Brain metabolism Chemical facter(o2 ,,co2,pH )
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mSAP-ICP
CPP
CBF

CVR
CVR
CBF cerebral blood flow SAP systemic arterial
pressure ICP intracranial pressure CPP cerebral
perfusion pressure CVR cerebrovascular resistance
Normal cerebral perfusion 9.3 - 12 kPa (70
-90 mmHg)
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Cushing's Response
Acute ICP?

Breath stop Heart stop beating
Blood pressure? pulse?
death
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clinical manifestation
three main symptom
headache vomiting papilledema
other manifestation
Abdupalsy ? amviopiapa ?conscious disturbance
blood pressure up ? Pulse slow
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ICP? dignosis
1 clinical manifestation symptom?sign ,death 2
assist examination
(1) Lumber puncture (2) x--ray (3) Cerebral
angiography (4) No hurt examination

CT?MRI
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ICP? treatment
1 General treatment 2 Delete etiology 3
Decrease ICP 4 Homone 5 Hibenation
hypothermy 6 CSF outside drainage 7 Babital 8
Assistant hyperventilation 9 antibiotics 10 Aim
at symptom
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Acute Brain Herniation Acute Cerebral Pressure
Cone
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Anatomy basis
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Brain Herniation
when some part of intracranial has mass, this
parts pressure surpass others close to it,thus
brain move from high pressure to low pressure and
produce seriers of clinic syndromes
Conception

Transtentorial herniation Transforamen magna
herniation Cingulate gyrus herniation
category
Etiology

(1) hematoma (2) tumor (3) abscess (4)
parasites (5) Chronical granuloma (6) Iatrogenic
illness
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acute herniation clinical manifestation
(?) Transtentorial herniation
(1) ICP (2) Conciousness alter (3) Pupil
alter (4) akinesia (5) Life sign disorder
(?)Transforamen magna herniation
(1) ICP (2) Life sign disorder (3) Neck
rigidity (4) Conciousness alter appear
later,respiratory arrest appear early,no
pupil alter
(?) Cingulate gyrus herniation
oppsite side akinesia,dysuresia
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acute herniation processing

• Decrease ICP
• Search etiology
• Operation early

(1) Cerebral ventricle outside drainage (2)
Decompression operation (3) v-p operation (4)
Inside decompression operation
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W.X. 21y
2000-5-26
2000-7-20
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W.X. 21y
2000-12-5
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W.X. 21y Glioma
Pre-operation
Post-operation
2000-12-9
2000-12-10