Intracranial hypertension syndrome

Introduction 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. The general intracranial pressure is usually 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.

Cause

Since the main components of the brain are brain tissue, cerebrospinal fluid and blood, the increase of these three components and the occupying lesions can lead to an increase in intracranial pressure.

(1) Increase in brain volume

1, cerebrovascular disease

Cerebral embolism, cerebral thrombosis and multiple lacunar infarction.

2, acute craniocerebral injury

Brain contusion and laceration, intracerebral hemorrhage, and brain surgery after craniocerebral trauma itself can account for edema around the lesion.

3, infection

Various brain abscesses, granuloma, viral encephalitis, and brain parasitic diseases such as cerebral cysticercosis, schistosomiasis, toxoplasmosis, etc., are more common in northern China with cerebral cysticercosis.

4, intracranial tumor

Glioblastoma, meningioma, astrocytoma, metastases, etc.

5, other

Such as febrile seizures, especially severe and persistent febrile seizures; acute cerebral hypoxia and heat stroke, water poisoning, etc.; systemic diseases such as pregnancy-induced hypertension syndrome, uremia, status epilepticus; nutrition, metabolic diseases; breathing, heart Stroke arrest can lead to cerebral edema.

6. Unexplained good examination of intracranial hypertension.

(two) increased cerebrospinal fluid

1, cerebrospinal fluid circulation obstruction

Common causes are congenital stenosis and atresia of the cerebral aqueduct; congenital abnormalities of the cerebellar tonsils are too long or down, such as Arnold-Chiari malformation; abnormal skull development and ventricular system tumors and cysts. Parasites, inflammatory adhesions, etc.

2, cerebrospinal fluid absorption disorder

Common causes are meningeal inflammation, after subarachnoid hemorrhage and after traumatic brain injury can lead to occlusion of arachnoid granules, affecting the absorption of cerebrospinal fluid, or affecting the absorption of cerebrospinal fluid by the venous plexus of spinal nerve roots, resulting in increased intracranial pressure.

3, excessive secretion of cerebrospinal fluid

The lesions found in the choroid plexus cause excessive secretion of secretory cells and inflammatory response of the meninges.

(C) increased intracranial blood volume

Mainly seen in venous sinus thrombosis, intracerebral phlebitis, thrombosis of large veins in the brain, and internal jugular vein thrombosis.

an examination

Related inspection

Brain CT examination

First, medical history

There are many causes of high intracranial pressure syndrome. Clinically, headache, vomiting, and fundus papilledema are the main features. Depending on the cause, it may be accompanied by signs of heat and meridian system, meningeal irritation, and coma. For patients with high intracranial pressure syndrome, detailed and reliable medical history and detailed physical examination are very important. Most patients can determine the cause of the diagnosis through the clinician's medical history and physical examination. When inquiring about medical history, attention should be paid to rapid onset, cerebrovascular disease, acute craniocerebral injury, infection, parasitic disease, intracranial tumor, metastatic cancer, febrile seizures, especially severe and persistent febrile seizures, carbon monoxide poisoning, heatstroke , water poisoning, systemic diseases such as pregnancy-induced hypertension syndrome, uremia, status epilepticus, nutrition, metabolic diseases, respiratory, cardiac arrest and other medical history. Children with congenital abnormalities such as congenital stenosis, atresia of the aqueduct, cerebellar tonsil malformation, abnormal skull development, and ventricular system tumors, cysts, parasites, inflammatory adhesions and other medical history.

Second, physical examination

For patients with increased intracranial pressure, careful examination can often confirm the diagnosis, including:

1 body temperature, pulse, respiratory rate and depth, respiratory odor and respiratory secretions;

2 blood pressure;

3 pupil size, whether the sides are equal and respond to light;

4 eyeball activities;

5 fundus edema, hemorrhage and exudation;

8 movement, sensation and reflex of the cranial nerve and spinal nerve;

9 meningeal irritation and so on.

Making timely judgments on the condition and choosing the most appropriate auxiliary examination will be of great help to diagnosis and treatment.

Third, auxiliary inspection

In addition to routine blood, urine, stool, electrocardiogram, chest X-ray and other examinations, patients with increased intracranial pressure should also choose to use auxiliary examination according to medical history and physical examination.

(1) Radiological examination

It is of great significance for the diagnosis of etiology, such as brain tumors, cerebrovascular diseases, hydrocephalus, and brain parasitic diseases. Patients with suspected increase in intracranial pressure should be examined for plain X-ray, CT or MRI.

MRI showed better lesions in the posterior fossa.

(two) continuous recording of intracranial pressure

If necessary, the pressure in various parts of the skull such as intraventricular pressure, brain tissue pressure, subdural pressure and epidural pressure can be continuously recorded.

(three) waist wear check

The diagnosis of increased intracranial pressure is mainly based on lumbar puncture, and the pressure of cerebrospinal fluid is measured. If the pressure of cerebrospinal fluid exceeds 1.96 kPa (200 mmH2O), the intracranial pressure is generally considered to be increased. In theory, the diagnosis of increased intracranial pressure should be diagnosed based on the pressure of cerebrospinal fluid. However, patients with increased intracranial pressure should be very careful when wearing lumbar puncture. If the cerebrospinal fluid is excessively worn during lumbar puncture, it is easy to induce cerebral palsy, especially when the chronic occipital foramen is extremely dangerous. Therefore, the indications should be strictly controlled, and the operation should be very careful. It is best to use a thinner waist. After the waist is worn successfully, the needle core should be pulled slowly. If the cerebrospinal fluid pressure is too high, the cerebrospinal fluid should be pulled out quickly. Puncture needle. If you have enough cerebrospinal fluid to check, don't put too much cerebrospinal fluid. And when doing lumbar puncture, 20% mannitol 250 ml, furosemide and hormonal drugs should be prepared for the treatment of intracranial pressure reduction.

Routine examination of cerebrospinal fluid and some special examinations are meaningful for definite causes. For example, when there are a large number of inflammatory cells in the cerebrospinal fluid, the intracranial inflammation is supported. The positive cysticercosis test supports intracranial cysticercosis, ie cerebral cysticercosis; tuberculosis antibody Positive positive support for intracranial tuberculosis infection; oligoclonal zone positive, more suggestive of brain demyelinating diseases.

Differential diagnosis

The diagnosis should be differentiated from the following symptoms:

1. Increased intracranial pressure

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.

2. Low intracranial pressure syndrome

Low intracranial pressure syndrome is a clinical syndrome characterized by orthostatic headache caused by various causes of cerebrospinal fluid pressure in the lateral subarachnoid space of 0.59 kPa (60 mmH2O). Low intracranial pressure syndrome is generally caused by a decrease in brain volume, a decrease in cerebrospinal fluid, or a decrease in blood volume in the brain, resulting in a decrease in total intracranial volume, which causes a decrease in intracranial pressure and causes a series of clinical manifestations. Its unique clinical manifestations have recently attracted people's attention, but many problems have not yet been elucidated. Clinically, this syndrome is not uncommon, and it is often misunderstood if it is not recognized. Clinically, it is often divided into symptomatic low intracranial pressure and primary low intracranial pressure.

3. Intracranial space-occupying lesions

In the normal human cranial cavity, there are mainly brain tissue, cerebrospinal fluid, cerebral blood vessels and blood flowing in the lumen. Under normal circumstances, the cranial cavity is completely closed, the volume of the cranial cavity and the volume of the contents contained therein are constant, and the intracranial pressure is maintained (about 0.686-1.96 kPa, or 70-180 mm water column). The so-called intracranial space-occupying lesion refers to a certain space in the cranial cavity occupied by focal lesions, causing clinical focal neurological symptoms, signs and increased intracranial pressure. This lesion is called intracranial space-occupying lesion.

4. Hydrocephalus

Hydrocephalus is a general term for cerebrospinal fluid production or circulatory absorption process, resulting in excessive cerebrospinal fluid volume, increased pressure, and enlarged space occupied by normal cerebrospinal fluid, which leads to increased intracranial pressure and ventricular enlargement.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.