Intracranial Hypertension Resident Survival Guide

Intracranial Hypertension Resident Survival Guide Microchapters
Overview
Causes
Diagnosis
Treatment
Do's
Don'ts

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sabeeh Islam, MBBS[2]

Synonyms and keywords:

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated. If intracranial hypertension left untreated, may cause:

• Transtentorial herniation
• Respiratory depression
• Coma
• Brain death

Common Causes

• Aneurysm 
• Arnold-chiari malformation
• Behçet's disease
• Brain tumor
• Cerebral edema
• Cerebral venous sinus thrombosis
• Choroid plexus tumor
• Chronic kidney disease
• Colloid cyst of third ventricle
• Contusions
• Crouzon craniofacial dysostosis
• Cushing's syndrome
• Dural arteriovenous fistula
• Encephalitis
• Epidural haemorrhage
• Epidural hematoma
• Erdheim-chester disease
• Excess cerebrospinal fluid
• Head trauma
• Hydrocephalus
• Hypertensive brain hemorrhage
• Hypertensive encephalopathy
• Idiopathic intracranial hypertension
• Intracranial granuloma
• Intracranial haemorrhage
• Intraventricular hemorrhage
• Meningioma
• Meningitis
• Meningoencephalitis
• Obstruction of superior mediastinal veins
• Obstruction of jugular veins
• Status epilepticus
• Stroke
• Subarachnoid haemorrhage
• Subdural haemorrhage
• Subdural hematoma
• Vasculitis
• Venous sinus thrombosis

Diagnosis and Treatment

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Do's

• Maintain oxygen
• Head elevation
• Hyperventilation to achieve a PaCO2 of 26-30 mmHg
• Osmotic diuresis with intravenous mannitol and Lasix
• Appropriate sedation, if patient requires intubation. Propofol is considered to be the preferred agent.
• Therapeutic hypothermia to achieve a low metabolic state
• Appropriate choice of fluids to achieve euvolemic state. Avoid hypotonic agents
• Allow permissive hypertension. Treat hypertension only when CPP >120 mmHg and ICP >20 mmHg
• Seizure prophylaxis with anticonvulsant therapy.