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What Is Intracranial Hypertension? - News-Medical.net
Intracranial pressure (ICP)Types of IHCauses and symptomsIdiopathic intracranial hypertensionCase reportDiagnosis and treatmentReferences Further reading
Intracranial hypertension (IH), a clinical condition typically seen in the intensive care unit, is caused by increased pressure surrounding the brain. In many situations, the cause of chronic IH is unknown, referred to as idiopathic IH (IIH).
It can be caused by a primary central nervous system (CNS) lesion or a consequence of another systemic condition. It leads to poor outcomes, including increased mortality.
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The normal intracranial pressure in adults is less than 15 mm Hg, with brief rises related to coughing or sneezing.
Sustained intracranial pressure values exceeding 20 mm Hg are considered pathogenic and should be treated aggressively in patients with traumatic brain damage. Intracranial volume and intracranial pressure have an exponential connection.
Pressure initially rises slightly with increasing volume, but when the system's buffering capabilities are exhausted, ICP can rise significantly. Intracranial and systemic events lead to increased intracranial pressure following traumatic brain injury.
In clinical practice, invasive and non-invasive ICP monitoring methods estimate the appropriate cerebral perfusion pressure (CPP).
Types of IHIntracranial hypertension can be acute or chronic; Acute IH can happen unexpectedly due to a severe head injury, stroke, or brain abscess, and the rare chronic type can be long-lasting with no known cause at times.
Idiopathic IH (pseudotumor cerebri) is characterized by elevated intracranial pressure with no apparent etiology.
Causes and symptomsIntracranial hypertension can occur due to several conditions caused by potential mechanisms, including venous blockage, cerebral edema, and increased brain and blood volume.
Chronic intracranial hypertension can occur due to a blood clot (on the brain's surface), tumor, or infection in the brain (meningitis).
IH can be caused by both primary and secondary brain injury (SBI) and has variable clinical symptoms. Headache, nausea, and vomiting, as well as diplopia, papilledema, and pupillary dilatation, are common symptoms.
Severe hypertension, bradycardia, and irregular breathing are also possible. A potentially fatal consequence of IH is brain herniation. Many kinds of brain herniation, such as uncal transtentorial, subfalcine, tonsilar, and transcalvarial herniation, can be seen in these patients.
Idiopathic Intracranial Hypertension Diagnosis and TreatmentPlay Idiopathic intracranial hypertensionIdiopathic intracranial hypertension is defined by signs and symptoms of elevated ICP with no known cause.
The condition is linked to obesity, and most patients are female (typically of reproductive age). Headaches (sometimes mimicking migraine or tension-type headaches), vision impairment (leading to sight loss), pulsatile tinnitus, and back pain are common symptoms of idiopathic intracranial hypertension.
The clinical presentation is widely diverse and can lead to delays in diagnosis. The condition is extremely rare, with an annual incidence of 0.9 per 100,000 people. In young obese women, the incidence increases drastically and affects 19 per 100,000.
The underlying pathophysiology is unknown; however, numerous aetiologies have been proposed. Obesity is linked to increased intraabdominal and intrapleural pressure, which can reduce CSF outflow by increasing venous pressure and raising ICP. Sleep apnea can also cause increased ICP due to hypercarbia and vasodilation.
Case reportThey presented a 43-year-old man who reported recurring pain around his right eye. The pain began around 5-6 weeks before admission, described as pressure-like, with a severity rating of 7/10.
The agony lasted about 10 minutes and then disappeared, with episodes occurring three to four times a day. The patient denied that there were any triggering causes. The patient was unaware of trigger points.
The patient denied experiencing any changes in speech, vision, balance, sensation, or strength. Tinnitus, hearing loss, photophobia, phonophobia, nausea, and vomiting were all denied by him. A recent CT chest indicated bronchiectasis, and the patient had recently received antibiotics for a respiratory tract infection.
He gained roughly 18 kg during the last few months. Prior medical history involves nasal polyps, diabetes, obesity, hypertension, and smoking. The patient appeared obese but healthy on general physical examination, with no abnormalities observed on cardiovascular, respiratory, or abdominal exams.
On neurologic assessment, his cranial nerves were found to be slightly asymmetric. The patient's symptoms resolved completely. His checkup was normal following the lumbar puncture, and he was started on acetazolamide 500 mg twice daily. The patient was asymptomatic three months later, with no negative effects from the treatment.
The sixth cranial nerve is frequently involved in IIH. However, the involvement of other cranial nerves is uncommon in this condition. They described a patient with IIH who had episodic unilateral retro-orbital pain and various cranial nerve anomalies without papilledema.
Imaging examinations ruled out other possibilities, and the fast relief of symptoms upon lumbar puncture confirmed that they were caused by intracranial hypertension. Atypical manifestations of such a severe yet manageable condition must be identified and addressed.
Diagnosis and treatmentA CT Scan, an MRI scan, a lumbar puncture, and assessments of eyes and vision can aid in establishing IH in a patient. The goal of treatment is to lower intracranial pressure, ease headaches, and maintain vision. Nonsurgical treatments include weight loss, acetazolamide, and topiramate as first-line therapy modalities.
According to the most recent traumatic brain injury recommendations, the primary goal of IH treatment is to keep ICP below 22 mmHg and CPP over 60 mmHg. Achieving these goals could make the difference between life and death for the brain.
The therapeutic measures for IH are divided into general preventative measures and those used in the acute period to reduce ICP and optimize CPP.
Progress in monitoring and understanding the pathophysiological mechanisms of IH enables the introduction of targeted therapies to enhance these patients' outcomes.
Although therapy for the fundamental cause of IH is the basic first approach, all efforts in the ICU should be directed against preventing SBI.
ReferencesWhat Is Brain Pressure? Symptoms Of Life-threatening Intracranial ...
Chronic IH can result in a blood clot on the brain, a brain tumour, a brain infection or a blood clot on the brain.
It can be life threatening if it is not diagnosed or treated.
Idiopathic Intracranial Hypertension - also known as IIH mainly affects women in their 20s and 30s and has been linked to being overweight, hormone problems such as Cushing's syndrome, taking the contraceptive pill, lack of red blood cells, lupus and kidney disease.
The cause of the condition is unclear.
Symptoms of chronic IH can include a constant headache - which can be worse in the morning and can occur while coughing, blurred or double vision, temporary loss of vision, feeling and being sick, drowsiness and irritability.
If IH comes on suddenly, it could be as a result of stroke, severe head injury, or a brain abscess.
Scientists have now discovered common obesity and diabetes drug reduces rise in brain pressure.
New research
Research led by the University of Birmingham, published in Science Translational Medicine, has discovered that a drug commonly used to treat patients with either obesity or Type 2 diabetes could be used as a new new way to lower brain pressure.
IHH causes disabling daily headaches and severely raised pressure around the nerves in the eye. It also causes permanent vision loss in 25 per cent of untreated people.
Think FAST: Symptoms of a stroke to look out for
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Brain pressure, also known as intracranial hypertension, can be acute or chronic
Over three years, researchers at the University of Birmingham examined whether GLP-1 agonist drugs - existing drugs used in the treatment of diabetes and obesity - could reduce intracranial pressure in an animal model of raised brain pressure.
"Treatments to lower brain pressure are lacking and new treatments are desperately needed," said Dr Alexandra Sinclair, of the University of Birmingham's Institute of Metabolism and Systems Research.
"The current primary treatment in IIH is acetazolamide and this does not work well for many patients, while also having such severe side effects that our previous trials have shown that 48 per cent of patients stop taking it.
"We have shown that the GLP-1 agonist extendin-4 significantly reduces brain pressure rapidly and dramatically, by around 44 per cent with significant effects from just ten minutes of dosing – the biggest reduction we have seen in anything we have previously tested.
"What's more, we found that the effects last at least 24 hours.
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"These findings are rapidly translatable into a new novel treatment strategy for IIH as GLP-1 agonists are safe and widely-used drugs used to treat diabetes and obesity.
"They are also potentially game-changing for other conditions featuring raised brain pressure, including stroke, hydrocephalus and traumatic brain injury.
"We are very excited that this novel treatment strategy could make a landmark change for future patient care."
The findings are due to be presented on September 8th and 9th in Vancouver at the International Headache Society Meeting, followed by the British Endocrine Society meeting in the UK.
The University of Birmingham is now due to begin a clinical trial to test GLP-1 agonist drug in patients with raised brain pressure.
Headaches With Vision Issues Could Signal Serious Condition
WOMAN'S DOCTOR. NO ONE LIKES HAVING A HEADACHE THAT JUST DOESN'T GO AWAY. IT'S JUST THERE FOREVER. BUT ADD VISION ISSUES INTO THE EQUATION AND IT CAN BE REALLY TERRIFYING. THESE ARE SOME OF THE SYMPTOMS BEHIND IDIOPATHIC INTRACRANIAL HYPERTENSION. THIS CONDITION HAPPENS WHEN PRESSURE INSIDE THE SKULL INCREASES FOR NO OBVIOUS REASON. DOCTOR JOHN MCIVOR WITH MERCY MEDICAL CENTER SAYS IT AFFECTS PREDOMINANTLY WOMEN OF CHILDBEARING AGE, ALONG WITH A HEADACHE BEHIND THE EYES. PATIENTS ALSO MAY HAVE A RINGING IN THE EARS THAT'S IN TIME WITH THEIR HEARTBEAT, AS WELL AS BRIEF PERIODS OF BLINDNESS. IT'S. IF YOUR EYE DOCTOR LOOKS IN YOUR EYES AND SEES THIS PICTURE, THIS IS A PICTURE OF BOTH EYES. AND WHAT'S DEMONSTRATED HERE IS THE OPTIC NERVE ENTERING THE BACK OF THE EYE. THIS IS CALLED THE OPTIC NERVE HEAD. USUALLY THIS SHOULD LOOK LIKE A VALLEY. NOW IT MAY BE DIFFICULT TO APPRECIATE, BUT THIS IS ACTUALLY A HILL. INSTEAD OF A VALLEY. THE OPTIC NERVE HEAD IS PROTRUDING INTO THE BACK OF THE EYE. THIS IS CALLED PAPILLEDEMA. NOW DOCTORS FIRST TRY TO TREAT THE SYMPTOMS WITH MEDICATION. IF THAT DOESN'T WORK, A PATIENT MAY EVENTUALLY OPT FOR SURGERY TO TRY AND DIVERT SPIN
Woman's Doctor: Headaches accompanied by vision issues could signal serious condition
Brief periods of blindness possible with idiopathic intracranial hypertension
Updated: 5:33 PM EDT Apr 1, 2024
Editorial Standards ⓘNo one likes having a headache that doesn't go away, but add vision issues, and it can really be terrifying.Vision comprises just part of the symptoms behind idiopathic intracranial hypertension, a condition in which pressure inside the skull increases for no obvious reason.Dr. Jon McIver, a neurosurgeon at Mercy Medical Center in Baltimore, told 11 News the condition affects predominantly women of child-bearing age.Along with a headache behind the eyes, patients also may have a ringing in the ears that's in time with their heartbeat, as well as brief periods of blindness.Doctors first try to treat the symptoms with medication. But if that doesn't work, a patient may eventually opt for surgery to divert spinal fluid or stenting of the major venous sinuses.
BALTIMORE —No one likes having a headache that doesn't go away, but add vision issues, and it can really be terrifying.
Vision comprises just part of the symptoms behind idiopathic intracranial hypertension, a condition in which pressure inside the skull increases for no obvious reason.
Dr. Jon McIver, a neurosurgeon at Mercy Medical Center in Baltimore, told 11 News the condition affects predominantly women of child-bearing age.
Along with a headache behind the eyes, patients also may have a ringing in the ears that's in time with their heartbeat, as well as brief periods of blindness.
Doctors first try to treat the symptoms with medication. But if that doesn't work, a patient may eventually opt for surgery to divert spinal fluid or stenting of the major venous sinuses.
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