1、Intracranial Hypertension,（颅内压增高）,Section 1,Intracranial hypertension (颅内压增高)Intracranial pressure (颅内压),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
2、 and measured through lumber puncture when patient is placed in lateral decubitus position,Lumber puncture,Measurement of intracranial pressure,Adult：80180mmH2O0.7-2.0KPa5-15mmHgChild：50100mmH2O0.5-1.0KPa(80 of adult,INTRACRANIAL HYPERTENSION,Intracranial pressure keeps on high status of more than 2
3、00mmH2O(2.0KPa),Etiology and Pathophysiology of Intracranial hypertension,The contents inside the cranial cavity,BrainCerebrospinal fluidBlood (2-11%),1. Intracranial occupying diseases,2. Volume increase of the brain tissue,Brain edemaLocation: Intracelluer Extracellure Size: Locale Diffuse Etiolog
4、y: CytotoxicVasogenicIschemic,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
5、vascular regulation center in the hypothalumus, etc.)Outflow occluded: venous drainage occlusion( thrombosis inside the venous sinus system),A,V,brain,Regulation of intracranial pressure,1.Cerebrospinal fluid: Main factor: CSF compressed into spinal canalIncrease absorbtionDecrease secretion,2. Cere
6、bral blood volum: Autoregulation and Cushing reaction,Regulation of intracranial pressure,Changes of brain blood flow,MAPICPCVR,CBF,CPP=MAPICP,CBF,CPP CVR,CBF: cerebral blood flow; MAP: mean arterial blood pressur ICP: intracranial pressure; CVR: cerebrovascular resistance; CPP: cerebral perfusion p
7、ressure;,Cushings reaction,Hypertension、Bradycardia,Respiration change Pulse pressure increase Other vital signs changes,volume/pressure curve,Volume (ml),Pressure (mmH2O),Clinical Manifestation,Headache,Vomitus,Clinical Manifestation,Papilledema,Clinical Manifestation,Diagnosis,History Signs Examin
8、ations,Examinations,LP：measure pressure CT & MRI：occupying diseases DSA：cerebrovascular diseases X-ray plan film,Examinations,ICP monitoring,Management,Treatment of primary disorders,Occupying：surgery Infection：anti-infection Edema others,急性硬膜下血肿,硬膜外血腫,Management,Oral agents： Dichlothiazide: 25-50mg
9、, tid Triamterene: 50mg,tid Acetazolamide ：25-50mg,tid,Intravenous agents： Mannitol：1-2g/kg,iv,q4-6h Glycerine：1-2g/kg,iv, q8-12h Furosemid：20-40mg,iv or im, q6-8h Albumin;：1040g,iv,Mannital （甘露醇）,Lowering ICP1) immediate plasma expansion: increase CBF and O2 delivery2) Osmotic effect: increased ser
10、um tonicity draws edema fluid from cerebral parenchyma,Supports the microcirculation by improving blood rheology (流变学) Possible free radical scavenging,Furosemide (速尿）,Loop acting diuretics may reduce ICP by reducing cerebral edema ( possibly by increasing serum tonicity), and may also slow the prod
11、uction of CSF.,They also act synergistically with mannitol.,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、
12、 relieve pain, etc,Brain Herniation,SECTION 2,When there is a significant asymmetrical pressure increase within the cranial cavity, the brain structures would be forced to enter another space, and the brain herniation will occur.,Categorization,Downward transtentorial herniations Cerebellar tonsilla
13、r herniations Subfalcine herniation Upward transtentorial herniations others,Downward transtentorial herniation,Downward transtentorial herniation results from an asymmetrical supratentoial mass that produces a vector with both a medially and an inferiorly directed force,Clinical Manifestations,Webe
14、r,s syndrom,Ipsilateral pupil dilation Contralateral hemiplegia,Brain stem:distortion, displacement, ischemia, edema, and hemorrhage, etc.,Cerebrospinal fluid: circulation obstruction Main arteries injury,Cerebellar tonsillar herniations,Displacement of the cerebellar tonsils into the foramen magnum
15、,and compression of the medullary oblongata,Manifestations of cerebellar tonsillar hernia,Headache、vomitus、neck rigidity.In late phase: severe headache and breathing stop suddenly,Original diseases External ventricular drainage Cranial decompression,Management,复习思考题 (Section 1)：1）颅内压增高的定义及其正常值？ 2）引起颅内压增高的原因？ 3）何为颅内压增高的“三主征”？ 4）请解释颅内压增高时的体积/压力反应。,复习思考题 （Section II） 1）什么是脑疝？引起脑疝的主要原因是什么？ 2）常见的脑疝有哪些？主要临床表现是什么？,中国国际神经科学研究所（ChinaINI） 首都医科大学宣武医院神经外科菅凤增 M.D. Feng-Zeng JIAN M.D.E-mail: ,Thank you for your attention,
