How to treat increased intracranial pressure

increased intracranial pressure - Sriamakrishnahospital

Pressure can build up inside your skull because of a brain injury or another health problem. Increased intracranial pressure (ICP) is a dangerous condition that can cause a headache. Pressure can also hurt your brain or spinal cord even more.

This kind of headache is a medical emergency that must be taken care of immediately. The faster you get help, the better your chance of getting better. 

The causes that might lead to the condition:

  • Excess cerebrospinal fluid
  • Bleeding into the brain
  • Swelling in the brain
  • Aneurysm
  • Blood pooling
  • Brain or head injury
  • Brain tumor
  • Infections such as encephalitis or meningitis
  • Hydrocephalus
  • High blood pressure
  • Stroke 

The symptoms of intracranial pressure:

  • Headache
  • Blurred vision
  • Feeling less alert than usual
  • Vomiting
  • Changes in your behavior
  • Weakness or problems with moving or talking
  • Lack of energy or sleepiness

The intracranial pressure signs that infants may show:

When their ICP is too high, babies may have some of the same signs of increased intracranial pressure as adults. Also, it could change the shape of their heads.

Infants still have soft plates in their skulls held together by tough fibers called skull sutures. When ICP goes up, the sutures in the skull may separate, and the soft plates may move apart.

If a baby’s ICP is too high, their fontanel may also stick out. The soft spot on the top of the head is the fontanel.

What might lead to an increase in intracranial pressure?

Brain bleeding, a tumour, a stroke, an aneurysm, high blood pressure, or an infection in the brain can cause increased ICP. The main goal of intracranial pressure treatment is to lower the high pressure inside the skull around the brain. Increased ICP can cause serious problems, such as brain damage that lasts for a long time or even death.

The tests that are recommended for patients with intracranial pressure:

If someone has signs of high ICP, they should immediately go to the doctor for intracranial hypertension. This medical emergency could cause brain damage if the person doesn’t get help quickly.

A doctor measures the ICP in millimeters of mercury (mm/Hg). Less than 20 mm/Hg is considered normal. When ICP goes above this, it may mean that ICP has gone up.

Along with these, there are other different tests like:

Nervous system exam:

This is to see how well you can use your senses, stay balanced, and think. When your doctor for intracranial hypertension looks into your eye with an ophthalmoscope, they may be able to tell if your pressure is high.

Spinal tap: 

This test measures the pressure of the fluid around the brain and spine.

CT scan:

This test uses X-rays to make detailed pictures of the head and brain.

MRI:

A big magnet and a computer are used in this test to find small changes in the brain tissue. It can give more information than an X-ray or CT scan.

What happens if the intracranial pressure is not treated?

Increased intracranial pressure can cause some serious complications, like:

  • Seizures
  • Stroke
  • Neurological damage
  • Death

How to treat increased intracranial pressure? Various treatment options are available:

How ICP is treated depends on what is causing it. Aside from treating the underlying causes, the most important thing to consider when treating a sudden rise in ICP is how to treat a stroke or brain injury.

A few major options include:

Medications:

Certain medications are recommended by the doctor depending on the severity of the pressure. In case it’s in an initial stage, medication is a great way to relieve the pain without any medical interventions. But the course of the intracranial pressure treatment has to be completed to avoid recurrence.

Draining the fluid:

In a few patients, the intracranial pressure may result from an extra cerebrospinal fluid; draining the extra fluid relieves the pressure.

Surgery:

Craniotomies use cranial drills to make holes in the skull to remove intracranial hematomas or relieve pressure on parts of the brain. A mass may cause ICPs that are too high in the head. If this mass is removed through a craniotomy, ICPs will go down.

Decompressive craniectomy is a drastic way to treat high ICP. In this procedure, a part of the skull is removed, and the dura mater is stretched to allow the brain to grow without squeezing it or causing it to herniate.

Ventilation:

When someone has a high ICP because of an acute injury, it is especially important to ensure they have a good airway, are breathing well, and are getting enough oxygen. When there isn’t enough oxygen in the blood (hypoxia) or too much carbon dioxide in the blood (hypercapnia), cerebral blood vessels widen, increasing blood flow to the brain and raising the ICP. 

When there isn’t enough oxygen in the brain, cells must use anaerobic metabolism to produce energy. This makes lactic acid and lowers pH, which widens blood vessels and worsens the problem.

Once the recommended treatment is performed, the brain specialists place an intracranial pressure monitoring device to monitor the pressure constantly. 

Can increased intracranial pressure resolve by itself?

Increased intracranial pressure can go away, but that is not the case in most patients. People with ICP are generally recommended to get treated to avoid recurrence.

Can intracranial pressure be prevented?

You can lower your chances of having high blood pressure, a stroke, or an infection, which can all lead to ICP. You should see a doctor immediately if you have any of these signs.

When should you call your doctor?

If you experience any of the following signs, its advisable to visit your doctor at the earliest as it helps in the management of increased intracranial pressure:

  • Severe headache
  • Blurred vision
  • Feeling less alert than usual
  • Vomiting
  • Changes in your behavior
  • Weakness 
  • Lack of energy

Outlook of the condition:

A sudden rise in ICP is a medical emergency that can end your life. The sooner someone gets help, the better their chances are. Many people do well with treatment, and someone who has had their ICP go up can still improve.


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