Intracranial hypertension

Introduction Intracranial pressure refers to the pressure exerted by the contents of the cranial cavity on the cranial wall. It consists of two factors: hydrostatic pressure and vascular dynamic pressure. Since the total volume of the cranial cavity is relatively fixed, the intracranial pressure is relatively stable. The normal person's supine intracranial pressure is about 1.33 kPa (10 mmHg). When the brain tissue is swollen, intracranial space-occupying lesions or excessive secretion of cerebral reef fluid, malabsorption, circulatory obstruction or excessive cerebral blood flow, the intracranial pressure is maintained at 2.0 kPa (l5 mmHg) or higher. (inreacranial hypertension).

Cause

1. Increased brain tissue volume, the most common cause is cerebral edema.

(l) vasogenic cerebral edema, brain trauma, intracranial hematoma, post-cranial surgery and meningeal vascular accidents.

(2) cytotoxic cerebral edema, cerebral ischemia, hypoxia, and toxemia.

(3) mixed brain edema.

2. Intracranial blood volume increases, carbon dioxide accumulation, hypothalamic or brainstem surgery stimulates the vascular movement center.

3. Increased cerebrospinal fluid volume, cerebrospinal fluid malabsorption and/or excessive secretion of cerebrospinal fluid.

4. Intracranial space-occupying lesions, intracranial tumors, abscesses, etc., the lesion itself occupies a certain volume, while the cerebral edema around the lesion or obstructing the circulation pathway of the brain back fluid can cause obstructive hydrocephalus.

an examination

Related inspection

Cerebrospinal fluid bacterial culture cerebrospinal fluid color cerebrospinal fluid occult blood test cerebral angiography

1. Headache: It is the most common symptom of intracranial hypertension. The higher the intracranial pressure, the more obvious the headache, and the more diffuse dull pain. Pain occurs in the morning, often with a continuous or paroxysmal aggravation. Any cause of increased intracranial pressure, such as coughing, defecation, etc., can aggravate the pain. Vomiting or excessive ventilation can reduce headaches. Acute intracranial pressure increases headaches, restlessness, often accompanied by jet vomiting.

2. Vomiting: generally has nothing to do with diet, with or without nausea before vomiting, often with jetting, and often accompanied by severe headache, dizziness, and severe vomiting when the headache is severe.

3. Visual impairment: manifested as transient black sputum, gradually developed into vision loss or even blindness. Fundus examination revealed papilledema, venous dilatation, and bleeding. Double vision can be manifested when oppression, acute intracranial hypertension can ignore the performance of papilledema.

4. Disorder of consciousness: irritability, apathy, dullness, lethargy, and even coma.

5. Epilepsy or a limbic seizure.

6. Changes in vital signs: high blood pressure, slow pulse and large flood, slow breathing and deep Cushing three main signs. The pulse of severe severe intracranial pressure can be less than 50 beats per minute, breathing about 10 times per minute, and systolic blood pressure can reach 24kPa (l80mmHg), which is a sign of cerebral palsy.

7. Cerebral palsy: The intracranial pressure rises to a certain extent, part of the brain tissue is displaced, and the cleft of the dura mater or the large hole of the occipital bone oppresses the nearby nerves, blood vessels and brainstem, producing a series of symptoms and signs. There are two common types of cerebral palsy:

(1) Cerebellar incision (): ipsilateral oculomotor palsy, manifested as drooping eyelids, enlarged pupils, slow or disappeared light reflection, varying degrees of disturbance of consciousness, changes in vital signs, Lateral limb paralysis and pathological reflexes.

(2) large occipital foramen (cerebellar tonsil): pain in the back neck and occipital, stiff neck muscles, forced head sleepiness, disturbance of consciousness, large and small incontinence or even deep coma, bilateral pupil dilated, light The reflection is dull or disappears, and the breathing is slow or suddenly stopped.

8. Auxiliary inspection

(1) lumbar puncture pressure measurement: puncture pressure measurement in the gap of L2 ~ 3, if the pressure > I. 8kPa (l3.5mmHg or l80cmH2O) can be diagnosed. Suspected of cerebral palsy, should not be worn by the waist.

(2) intracranial pressure monitoring: accurate pressure measurement compared with lumbar puncture, can dynamically understand changes in intracranial pressure.

a. Mild increase: pressure is 2.0 to 2.7 kP. (15 to 20 mmHg).

b. Moderate increase: 2.8 to 5.3 kP (21 to 40 mmHg).

c. Severe increase: >5.3kP (40mmHg).

(3) cerebral angiography, CT and magnetic resonance can indirectly diagnose intracranial hypertension.

Differential diagnosis

The symptoms of intracranial hypertension need to be differentiated from the symptoms below.

First, hydrocephalus

(1) Medical history

1. Congenital hydrocephalus: Symptoms at birth, such as the more common Dandy-Walk abnormalities (fourth ventricle atresia, fourth ventricle dilatation, long head or cysts formed at the cerebellar end of the cranial fossa) Have a family history.

2. Secondary hydrocephalus: may have a history of encephalitis and meningitis, or a history of intracranial hemorrhage after birth.

3. Most patients have large heads, intelligent backwardness, lack of energy, lethargy, developmental stunting and malnutrition.

(2) Physical examination

1. The head circumference is enlarged, the cardia bulges, the cranial suture is split, the shape of the skull is rounded, the percussion has a broken pot sound, the skull is thin, and even the translucent shape. Venous engorgement can be seen in the forehead and ankle. The skull transillumination test was positive.

2. Both eyes fall into the shape of the sun, and most patients have nystagmus.

3. Patients often have tics, or have repeated seizures. In addition, cranial nerve palsy, limb paralysis, high muscle tone or ataxia can be seen.

(3) Auxiliary inspection

1. The head line examination or CT examination shows that the cranial cavity is enlarged, the skull is thinned, the cranial suture is separated and the anterior ankle is enlarged.

2. The side chamber was injected with neutral phenol red 1m1, lumbar puncture was performed within 2 to 12 minutes, and phenol red was observed in CSF, suggesting non-obstructive hydrocephalus. If phenol red does not appear in the CSF for 20 minutes, it is suggestive of obstructive hydrocephalus.

3. Ventricular angiography, slowly injecting filtered oxygen into the ventricles, and then X-ray examination, can observe the enlargement of the ventricles and thinning of the cerebral cortex. If the thickness of the cerebral cortex is more than 2 cm, and the hydrocephalus can be removed, the patient's intelligence is expected to recover. At the same time, ventriculography can also help identify obstructed areas or find intracranial tumors.

Second, cerebral hemo

Diagnostic points can be diagnosed based on detailed medical history data and physical examination: patients are more than 50 years old, have a history of hypertension and arteriosclerosis; more often in emotional or physical labor; sudden onset, headache after onset, Nausea, vomiting, half of patients with conscious disturbance or convulsions, urinary incontinence; may have obvious local signs, such as hemiplegia, meningeal irritation; blood pressure increased significantly after onset; CT scan and MRI visible hemorrhage, cerebrospinal fluid can be bloody.

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