Increased intracranial pressure

Introduction Normal adult intracranial pressure is 0.8 to 1.8 kPa, and children are 0.5 to 1 kPa. Increased intracranial pressure means that the pressure generated by the contents of the cranial cavity on the cranial wall exceeds the normal range, that is, the patient's lateral position is used for lumbar puncture, and the cerebrospinal fluid hydrostatic pressure exceeds 2 kPa. Cranial hypertension is not only a very common syndrome in neurosurgery, but is also common in other subjects.

Cause

There are many reasons for causing high blood pressure, and the following are common:

(A) craniocerebral injury: due to intracranial vascular rupture to form a hematoma, brain contusion and laceration caused by cerebral edema, traumatic subarachnoid hemorrhage, clot clotting caused by blood clots, etc., can lead to high blood pressure.

(B) intracranial tumors: about 80% of patients with the performance of intracranial hypertension, in general, the larger the tumor, the more obvious the intracranial hypertension; but the tumor located in the ventricle and midline, although the volume is not large, due to energy Obstructive hydrocephalus occurs, but there is a significant intracranial hypertension.

(C) intracranial infection: meningitis, brain abscess and so on.

(4) Cerebrovascular diseases: including cerebral hemorrhage, subarachnoid hemorrhage, hypertensive encephalopathy, internal carotid artery thrombosis and cerebral embolism.

(5) Cerebral edema: an important cause of increased intracranial pressure. In addition to brain diseases, the following systemic diseases can also produce varying degrees of cerebral edema: a. toxic encephalopathy caused by bacterial infection; b. acidosis , uremia, hepatic coma, cardiac dysfunction, etc.; c. coma patients with respiratory obstruction, asphyxia, cardiac arrest, carbon monoxide poisoning and hypoxic encephalopathy (epileptic state), etc., can lead to cerebral hypoxia, and secondary brain Edema, causing increased intracranial pressure.

an examination

Related inspection

Cerebral angiography, brain CT, brain MRI, EEG, brain function imaging

(A) headache is the most common symptom of intracranial hypertension, characterized by progressive or paroxysmal aggravation, obvious when getting up early in the morning, or can wake up at night. Headaches are usually located in the eyes and forehead, and the posterior fossa lesions are mostly in the neck. It is often exacerbated when forced by coughing or sneezing. Children's cranial sutures are not closed or closed tightly. When the intracranial pressure is increased, the widening of the suture can relieve the intracranial pressure, so the headache is not obvious or does not appear.

(B) vomiting is characterized by jet vomiting, often in the case of severe headache, headache can be temporarily relieved after vomiting. Generally not related to diet, so vomiting for unknown reasons, especially in children should consider cranial hypertension.

(C) papilledema is one of the important objective signs of intracranial hypertension. Acute intracranial hypertension is rare, and more than 70% of patients with chronic intracranial hypertension such as brain tumors have papilledema. Most are bilateral, but the degree of edema on both sides is not necessarily equal. Early does not affect vision, with the increase of papilledema, secondary optic atrophy, vision loss, and gradually blind.

(4) Other patients with increased intracranial pressure may have nerve palsy, diplopia, black sputum, mental retardation, apathy, high blood pressure, and slow pulse. Children with cranial hypertension often have enlarged head circumference, cranial suture separation, and scalp vein. Expansion, increased tension in the front of the squat door, etc.

The cranial volume increases or the cerebrospinal fluid circulation path is blocked, causing obstructive hydrocephalus and increasing intracranial pressure. The basic X-ray signs are:

Children's head enlargement, widening of the cardia, separation of cranial sutures, thinning of the skull, and increased cerebral gyrus; adults are mainly saddleback and saddle bones with saddle and saddle bones blurred or disappeared.

Differential diagnosis

Differential diagnosis of increased intracranial pressure:

1. High intracranial pressure syndrome: High intracranial pressure syndrome is a common syndrome in neurology. It refers to the pressure in the cranial cavity, that is, the increase in intracerebral pressure. Generally, intracranial pressure is commonly expressed by the pressure of cerebrospinal fluid in the subarachnoid space. Clinically, headache, vomiting and papilledema are the main features. Normal intracranial pressure refers to the pressure measured by the lumbar puncture of a normal person in a horizontal position: 0.78-1.76 kPa (80-180 mm H2O) for normal adults and 0.49-0.98 kPa (50-100 mm H2O) for children. If the pressure exceeds 1.96 kPa (200 mmH2O), it is generally considered that the intracranial pressure is increased.

2, increased intracranial pressure: normal people have a certain pressure in the skull, called intracranial pressure (referred to as intracranial pressure), usually refers to the horizontal position, the body is relaxed, the lumbar puncture is connected to a certain inner diameter of the tube The pressure is measured and is therefore exactly called cerebrospinal fluid pressure. In the lateral position, when the average cerebrospinal fluid pressure of an adult exceeds 1.96 kPa (equivalent to 200 mm water column), it is called an increase in intracranial pressure. Increased intracranial pressure is a group of syndromes common to many diseases that are common in clinical practice.

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