Increased intracranial pressure
Alternative names:
ICP; intracranial pressure - increased; intracranial hypertension
Treatment:
This condition is critical, meaning that death is possible
or imminent. The affected person will be in the hospital,
and most likely, in an intensive care unit. He or she will
be intubated (given a breathing tube), given medication, and
monitored closely. Efforts will be made to identify the source
of the pressure and appropriate steps will be taken to try
to relieve the pressure in the skull, whether surgically or
otherwise.
There are several potential therapies, which are provided
depending on the cause, severity, or resistance to treatment
of the raised ICP. Some of these are as follows:
- Sedatives to minimize agitation
- Mannitol - a water-soluble sugar that when injected into
the bloodstream draws water from swollen brain tissue.
- Hyperventilation - using a mechanical ventilator to force
a rapid repiratory rate. This causes excess carbon dioxide
to be blown off, which in turn causes a decrease in brain
blood volume and hence ICP.
- Surgery or CSF removal - removal of mass lesions can lower
ICP as will drainage of excess spinal fluid.
- Pentobarbital - a medication that completely anesthetizes
the brain, decreasing the need for blood flow and thereby
lowering ICP
- Hypothermia - lowering the temperature of the brain will
lower its demand for blood flow.
The treatment process can be prolonged and difficult, and
many different therapies may have to be tried.
Expectations (prognosis):
Brain herniation may be fatal. Slow increases in pressure
can be tolerated fairly well if the condition causing the
increased pressure is controlled. Young people with head trauma
may do remarkably well, as may infants. There is increased
likelihood of disability as the duration of treatment increases.
Also, being in coma worsens prognosis.
Complications:
- brainstem herniation - brain pushes through the opening
in the back of the skull where the spinal cord is attached
- hypoxic brain damage - brain damage due to reduced oxygen
supply to the brain
- cranial nerve palsies - complete paralysis of nerves that
supply the head and face
Calling your health care provider:
Children and adults with increased intracranial pressure
are, by the time the diagnosis is made, in the hospital.
Update Date: 05/08/00
Lyle J. Dennis, MD Fellow in Critical Care Neurology and Epilepsy
and Electroencephalography Columbia-Presbyterian Medical Center
VeriMed Healthcare Network
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