Hypertension颅内压升高课件.pptVIP

Intracranial Hypertension （颅内压增高） Intracranial Pressure (ICP) The pressure arising from the contents inside the cranial cavity against the wall of the cranio (skull) Usually represented by the pressure inside the subaracnoid space and measured through lumber puncture when patient is placed in lateral decubitus position INTRACRANIAL HYPERTENSION Etiology and Pathophysiology of Intracranial hypertension 3. Increase of the cerebrospinal fluid volume Absorption decrease (aracnoid villi, venous sinus) Circulation disorder Secretion increase (Choroidal plexuses) 4. Increase of the cerebral blood volume Inflow increased: blood vessels dilation (CO2 cumulation, injury of the vascular regulation center in the hypothalumus, etc.) Outflow occluded: venous drainage occlusion ( thrombosis inside the venous sinus system) Regulation of intracranial pressure Changes of brain blood flow Cushing’s reaction volume/pressure curve Clinical Manifestation Headache Vomitus Papilledema Diagnosis History Signs Examinations Examinations LP：measure pressure CT MRI：occupying diseases DSA：cerebrovascular diseases X-ray plan film Examinations ICP monitoring Management Management Mannital （甘露醇） Lowering ICP 1) immediate plasma expansion: increase CBF and O2 delivery 2) Osmotic effect: increased serum tonicity draws edema fluid from cerebral parenchyma Furosemide (速尿） Loop acting diuretics may reduce ICP by reducing cerebral edema ( possibly by increasing serum tonicity), and may also slow the production of CSF. Management Corticosteroids：reduce brain edema Hypothermia：slow down brain metabolism Barbiturate：combined with hypothermia Excessive ventilation：cerebral blood vessel contraction Antibiotics：infection control Symptomatic treatment：sedation、 relieve pain, etc Categorization Downward transtentorial herniations Cerebellar tonsillar herniations Subfalcine herniation Upward transtentorial herniations others Downward transtentoria