Intracranial Hypertension

Book Description:

Intracranial hypertension (ICH) is the most common cause of clinical deterioration and death for neurological and neurosurgical patients. There are a lot of causes of raised intracranial pressure (ICP) and increased ICP can produce intracranial hypertension syndromes. Monitoring of intracranial pressure and advances in investigations of the central nervous system have led to new concepts and systemizations in intracranial hypertension.The descriptive classification of the intracranial hypertension has been replaced by an etio-pathogenic classification with four main groups:

1. Parenchymatous Intracranial Hypertension, in the extending intracranial processes (cerebral tumors, intracranial haematoma, cerebral abscesses, etc.), in traumatic brain edema, in hypotoxic brain edema, in general intoxications with neurotoxins (endogenous or exogenous), etc.
2.Vascular Intracranial Hypertension, caused by the disorders of cerebral blood circulation and then the brain edema or / and brain swelling appears. The vascular intracranial hypertension occurs in : I. - vascular cerebral diseases : cerebral venous thrombosis or in in cerebral ischaemic stroke and in II. - extracerebral vascular diseases as hypertensive encephalopathies.
3.Intracranial Hypertension caused by the Disorders of the CSF dynamics ( hydrocephalus etc)
4.Idiopathic Intracranial Hypertension.

The treatment of intracranial hypertension depends on the type of intracranial hypertension and on the stage of the illness.

Authors: Stefan Mircea Iencean, (Emergency Hospital "Prof Dr Nicolae Oblu" Iasi, Romania); Alexandru Vladimir Ciurea, (The University of Medicine and Pharmacy, Bucharest, Romania)

Table of Contents:

Preface

I.Intracranial Hypertension - General Approach
1.General Approach and Short History
2.Classification of Intracranial Hypertension

II.Introduction to Anatomy and Physiology
1.Craniospinal Space
2.Nervous Parenchyma
3.Ventricular System
4.Vessels of the Brain and Cerebral Hemodynamics
5.Brain Blood Barrier
Structure and Functions
Alteration of Brain Blood Barrier
6.Cerebrospinal Fluid
Cerebrospinal Fluid Production
Cerebrospinal Fluid Circulation
Cerebrospinal Fluid Absorbtion
7.Dynamics of Intracranial Fluids

III.Intracranial Pressure
1.General Considerations
2.Intracranial pressure relationships
3.Intracranial Pressure Waves
4.Intracranial Pressure Increase
5.Compensating Mechanisms
6.Intracranial Pressure Measurement

IV. Pathogenesis of Intracranial Hypertension
1. General Considerations
2. Alteration of Nervous Parenchyma
Brain Edema
3. Alteration of CSF Physiology
Hydrocephalus
4. Cerebrovascular Reactivity
5. Decompensation of Intracranial Hypertension
Brain Ischemia
Brain Herniations

V. Clinical Presentation
1.Headache
2.Papilledema.
3.Nausea and Vomiting
4.Psychic Disorders
5.Intracranial Hypertension in Infants and Children
6.Intracranial Hypertension in Elderly Patients

VI.Decompensation of Intracranial Hypertension
1. General Considerations
2. Consciousness Disorders and Coma
3. Focal Neurological Deficit
4. Cranial Nerves Palsies
5. Vegetative disorders
6. Decompensated intracranial hypertension

VII. Paraclinical Explorations
1. Ophtalmological Examination
2. X-ray
3.Computerised tomography scanning
4.Magnetic resonance imaging
5.Intracranial Pressure Monitoring

VIII. Intracranial Hypertension Classification
1. Parenchymatous Intracranial Hypertension
2.Vascular Intracranial Hypertension
3.Intracranial Hypertension caused by the Disorders of the CSF Dynamics
4.Idiopathic Intracranial Hypertension

IX. Differential Diagnosis
1.Clinical Different Diagnosis
2.Ethiological Different Diagnosis
3.Evolutive Diagnosis

X. Parenchymatous Intracranial Hypertension
1.Acute Parenchymatous Intracranial Hypertension
Intracranial Hypertension in Traumatic Brain Injury
Acute Non-traumatic Intracranial Hypertension
2.Progressive Parenchymatous Intracranial Hypertension
Low-grade Gliomas
High-grade Gliomas
Brain Metastases
Benign Intracranial Tumors
Intracranial Hematomas

XI. Vascular Intracranial Hypertension
1. Cerebral Venous Thrombosis
2. Hypertensive Encephalopathy
3. Ischaemic Stroke

XII. Intracranial Hypertension Due to Disorders in the Cerebrospinal Fluid Dynamics
1. Obstruction of CSF Pathways and Obstructive Hydrocephalus
2. Decreased Absorption of CSF

XIII. Idiopathic Intracranial Hypertension
1. Diagnosis Criteria
2. Clinical Presentation
3. Investigations
4. Treatment

XIV. Evolution and prognosis

XV. Treatment of Intracranial Hypertension
1. Etiologic treatment
2. Pathogenic Treatment
3. Symptomatic Treatment

XVI.Intracranial Hypotension

Index