In the skull is the brain, which is also surrounded by fluid.
This fluid is also found in the spaces between the two halves of the brain. The spaces are called liquor spaces, the fluid is called liquor (German: brain water). The cerebral water protects the brain from vibrations and is supposed to feed the brain cells, but this has not been adequately researched.
The cerebral water flows through the liquor spaces at a certain pressure. This pressure is known as intracranial pressure (ICP). After the liquor has flowed through the liquor spaces, it is absorbed and fed into the venous blood circulation. Normally the intracranial pressure is located at values between 5 and 15 mmHg. If the values rise beyond that, the intracranial pressure is increased and is associated with various complaints and symptoms.
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The typical symptoms that patients with increased intracranial pressure develop are usually mild at the beginning and can easily be associated with a gastrointestinal (gastrointestinal tract) cause. Nausea (Nausea) can occur with increased intracranial pressure, and vomiting can also occur. Another gastrointestinal symptom, the patient may develop loss of appetite. Another complex of symptoms relates to the area of the head and the whole body. The patient with cerebral edema often has headaches and suffers from fatigue. Furthermore, attention and the ability to concentrate are reduced (vigilance disorder). The patient may also be restless.
Special symptoms are also possible. The decortication rigidity should be mentioned here. Rigid decortication is the spastic flexion position of the arms and the simultaneous rigidity of the legs. The decortication rigidity occurs as a result of changes in the brain (disinhibition of certain regions) due to the increased intracranial pressure. Another special symptom is rigor decerebral: this describes a spastic stretching of the arms and legs, also as a result of disorders of the brain caused by the increased intracranial pressure.
$config[ads_text2] not foundThe main symptoms of the increased intracranial pressure are headache, vomiting and a congestive papilla. The congestive papilla must be determined by an ophthalmologist through a reflection of the fundus. Headache, vomiting and papillae are collectively referred to as the intracranial pressure triad. If the increased intracranial pressure is not recognized as the trigger for the symptoms, the symptoms can increase with dizziness and eye muscle paralysis. In addition, the consciousness can cloud more and more and the patient can eventually fall into a coma.
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Increased intracranial pressure usually becomes symptomatic very quickly (from a pressure increase of> 22mmHg; physiological is an intracranial pressure of 5-15mmHg), but initially they are often mild, more general complaints that can easily be incorrectly assigned to the gastrointestinal tract.
In addition to nausea and vomiting, loss of appetite can also be noticed.
Frequently encountered are also
Edema in the tissue of the optic nerve is characteristic and groundbreaking in diagnostics (so-called congestive papilla) found in an eye exam (Ophthalmoscopy) can be noticed. Other symptoms can include eye muscle paralysis with impaired vision and breathing disorders (Biot breathingIn addition, the Cushing reflex can lead to an increase in blood pressure and a decrease in heart rate.
If the intracranial pressure remains untreated and continues to rise, disturbances of consciousness occur, which can sometimes even lead to a coma.
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$config[ads_text3] not foundRead more about it: What are the signs of a cerebral hemorrhage?
If, in addition to the common symptoms such as headache, nausea and vomiting, neck stiffness occurs with increased intracranial pressure, this can be an indication of the presence of meningitis (meningitis) as the cause of the increase in intracranial pressure. Photophobia and the occurrence of fever would also fit this diagnosis. Meningitis is an absolute medical emergency and should result in an immediate medical consultation! If the symptoms consist only of a headache and stiff neck and there is no fever, tension in the neck muscles is more likely to be the cause of the symptoms. This, in turn, usually results from one-sided physical strain or predominantly sedentary work without sufficient physical exercise.
Read more on the subject at: Signs of meningitis
Signs of intracranial pressure are clinical symptoms and examination findings that suggest the presence of increased intracranial pressure.
The first signs of an increase in intracranial pressure are often mistakenly misinterpreted as a gastrointestinal infection. In addition to headache, nausea and vomiting, the most important signs of intracranial pressure include loss of appetite and fatigue. In contrast, some sufferers also feel an unusual unrest. Long-term increased intracranial pressure can lead to impairment of the optic nerve, so that visual disturbances (reduction in visual acuity) and the congestive papilla (see above) that can be identified by an eye examination are counted among the signs of intracranial pressure.
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Read more on the subject at: Intracranial pressure sign
Increased intracranial pressure can have many different causes. The various causes can roughly be assigned to two categories. On the one hand, the intracranial pressure increases when there is an obstruction to drainage; on the other hand, the intracranial pressure increases when too much brain water is formed or there is too much water in the brain due to certain processes.
The drainage pathway of the cerebral fluid can be blocked by a tumor that is growing uncontrollably. It therefore reaches important structures after a certain time and infiltrates them, i.e. it grows into body structures and thus destroys them. This can also happen in the CSF system. When a tumor grows into the liquor spaces, these are eventually blocked. However, the body continuously creates new brain water, so that a kind of congestion occurs and thus the pressure naturally increases.
The cerebral fluid can also be prevented from draining by an abscess. An abscess is an encapsulated collection of pus in a body cavity created by the melting of tissue. Abscesses can have many different causes and often arise for no apparent reason. Here, too, the brain water accumulates, which causes an increase in intracranial pressure.
Cerebral haemorrhage can also be a cause of obstruction to drainage. This can result from an existing high blood pressure.The blood that escapes from the vascular system displaces the surrounding brain tissue and can compress the brain. The bleeding can also break into the ventricular system (liquor spaces). This can lead to circulatory disorders of the cerebral water.
The increase in fluid occurs in the so-called brain edema (Brain swelling) on. Damage to the blood-brain barrier leads to an influx of water and cerebral edema. The brain edema and thus the increase in intracranial pressure can in turn have several different causes:
The traumatic brain injury caused by an accident can lead to the development of brain edema. Any injury to the head or skull that involves the brain is referred to as a traumatic brain injury. Since there is always the risk of cerebral edema, cerebral hemorrhage and other complications, every patient with a traumatic brain injury should be admitted to the hospital for observation.
The development of cerebral edema can also be toxic (poisonous). This means that brain edema can be triggered by certain poisons.
$config[ads_text1] not foundIn addition, brain edema can have a metabolic cause, i. that a metabolic process can be the trigger (metabolism = metabolism).
Another cause of brain edema can be hypoxia. Hypoxia is a lack of oxygen in the tissue. So when the brain is undersupplied, it can react by swelling. A major cause of a lack of oxygen is a cerebral infarction (ischemic insult). During a cerebral infarction, the blood supply to the brain is interrupted for various reasons. Since the brain and the entire body are generally supplied with oxygen via the blood, an acute lack of oxygen occurs.
Just as the arterial vascular system is blocked in a cerebral infarction, the venous outflow of the blood can also be disturbed. This is generally called thrombosis, in the brain it is called sinus vein thrombosis. The outflow of blood is blocked by this sinus vein thrombosis. Since the cerebral water also drains through the venous blood, this is similar to an obstruction to the drainage in the liquor spaces. The pressure increases and the brain swells, which causes the intracranial pressure to increase.
The brain edema can also have inflammatory causes. For example, it can be a complication of a bacterial infection (for example, meningoencephalitis caused by meningococci, i.e. meningitis).
Ultimately, space-occupying processes can also trigger cerebral edema and thus an increase in intracranial pressure. A common space occupying process is the growth of a tumor. Furthermore, an abscess can trigger pressure on the surrounding tissue. Bleeding and hematomas can also trigger cerebral edema and subsequently increased intracranial pressure.
Brain edema can also result from contact with high voltage electricity. This means that caution is advised after a high voltage accident.
The possible, but nonetheless atypical side effects of overdosed L-thyroxine therapy in the case of hypothyroidism include fever and vomiting as well as increased intracranial pressure, which can be observed in children in particular.
The occurrence of L-thyroxine-induced increased intracranial pressure is also known as idiopathic intracranial hypertension, which occurs most frequently in women around the age of 30, but in 37% of cases also affects children, especially between the ages of 5 and 15 (Boys and girls are equally affected).
As the name "idiopathic" suggests, the exact cause for the development of the increased intracranial pressure is still unknown, but studies have shown certain risk factors such as the intake of L-thyroxine in childhood, which promote the development of idiopathic intracranial hypertension.
Read more about this: L-thyroxine
Other hormonal disorders (apart from the thyroid) can also lead to the symptom constellation. These can arise in the context of endocrinological diseases or tumor diseases. Cushing's syndrome is an example of this. This is an increase in the level of cortisone in the blood either through the body's own increased production or through long-term use of cortisone-containing drugs.
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You might also be interested in this topic: Side effects of cortisone
Stress is a physical condition in which the body uses hormones to increase energy consumption, stimulates the cardiovascular system and can lead to various symptoms. The triggers for stress can be explained physically and mentally. In many situations, increased intracranial pressure can occur together with stress. However, the stress does not have to be the cause of the increased intracranial pressure. Rather, the stress is often another symptom of an underlying medical condition.
Stress can be associated with increased intracranial pressure, especially in children. Other symptoms include sweating, racing heart, weight loss, and insomnia.
An already existing increased intracranial pressure can often lead to a slight feeling of stress. A slight increase in intracranial pressure of around 10mmHg can lead to feelings of restlessness, nervousness and subjectively perceived physical stress.
A general prognosis cannot be made for increased intracranial pressure due to the many possible causes.
In the case of traumatic brain injuries, the extent of the increase in intracranial pressure and the time elapsed before treatment have a decisive influence on the prognosis, which offers the complete spectrum from complete recovery within a few weeks to death. There is a similar range of prognosis for stroke. Even if a tumor is the cause of the increased intracranial pressure, the prognosis strongly depends on the type and extent of the tumor and on whether the tumor has already spread at the time of diagnosis.
In the case of an inflammatory, toxic or stress-related increase in intracranial pressure, on the other hand, the situation can often be improved with medication and thus complete or extensive freedom from symptoms can be achieved.
Increased intracranial pressure can, depending on the severity, sooner or later trigger irreversible damage to the brain.
While an acute, strong increase in intracranial pressure, for example due to a traumatic brain injury, can lead to a coma within a very short time and become life-threatening, an only slightly increased intracranial pressure unfolds its harmful effect on the brain over the course of several weeks or months. Therefore, increased intracranial pressure should always be treated immediately, regardless of the extent and cause!
The impairment of the brain as a result of a long-term increase in intracranial pressure manifests itself in addition to the symptoms mentioned above (especially headache, vomiting, nausea) through a reduced resistance of those affected in everyday life. Visual disturbances can also occur: the increased intracranial pressure attacks the optic nerve, which carries visual information from the eye to the brain. If adequate therapy is not carried out over a long period of time, further, more serious neurological restrictions can arise, such as movement disorders, deafness or speech disorders.
If a patient has increased intracranial pressure, he must always be monitored by intensive care.
The head must be positioned straight so that the outflow of blood is not obstructed. The patient should hyperventilate slightly as this leads to constriction of the blood vessels, decreases blood flow and has a lowering effect on intracranial pressure. Drugs can be used to give the patient diuretics to increase fluid excretion and thus reduce cerebral edema. In addition to the diuretics that act on the kidneys, osmotically acting diuretics such as mannitol can also be given. These pull the water out of the tissue into the blood and thus have a short-term decongestant effect, especially in the case of critical brain edema. The patient should also be sedated, as sedation can reduce the metabolic needs of the brain. This then lowers the blood flow to the brain, which has a lowering effect on intracranial pressure. If the pressure is too high, it may be necessary to drain the cerebral fluid by means of an external ventricular drainage. A last resort can be a decompression craniectomy.
A puncture of the external liquor spaces can be contraindicated, as there is a risk of brain entrapment.
According to new findings, hyperventilation is a therapeutic option for increased intracranial pressure in short-term crisis situations.
In the case of severe climbs in a short time, hyperventilation can make an important contribution due to its ease of implementation. By exhaling the carbon dioxide, the arterial vessels constrict, which leads to a slight drop in intracranial pressure. However, this effect only lasts for about 4-6 hours. Hyperventilation should by no means serve as the sole therapy. It only works to support rapid increases in pressure.
There are no real home remedies for lowering increased intracranial pressure. A doctor should always be consulted and his therapy guidelines should be followed. Nevertheless, a few simple suggestions for everyday life can improve the well-being of patients with increased intracranial pressure: For example, elevating the head by around 30 ° at night is recommended (no more than that, otherwise there is the risk of reduced blood flow to the brain takes!).
In addition, those affected should be shielded from noise, bright light and psychological stress as much as possible by their environment. In addition, care should be taken to ensure that the body temperature is not increased too much above the normal range of 36-37 ° C, as this can lead to increased blood flow to the brain and thus to a further aggravation of the increased intracranial pressure. It is also advisable to monitor the amount of drinking and urine excretion: Here you should pay attention to a slightly negative or at least balanced balance in order to "dehydrate" the body, so to speak.
As a rule, those affected initially complain of headaches and nausea, which is why they first consult their family doctor.
If the patient finds evidence of increased intracranial pressure based on the patient's descriptions, he will arrange for a referral to a neurologist or, in more urgent cases, an emergency hospital admission. Either way, the diagnosis and treatment of increased intracranial pressure is the responsibility of the neurologist. Although this is about during the eye examination (Ophthalmoscopy) can call in an ophthalmologist and the evaluation of CT or MRI images is accompanied by a radiologist anyway, the neurologist is the treating doctor and also the central contact for follow-up.
In order to be able to direct a first suspicion of increased intracranial pressure, the symptoms must be inquired about exactly. The body can compensate for a certain increase in pressure. Depending on the individual, a further increase leads to nausea, headaches, tiredness and nervousness. In the further course, there are increased blood pressure, reduced heart rate and slight shortness of breath. At this stage at the latest, the person concerned must be examined for certain signs of intracranial pressure.
A popular test procedure for this is the examination of the eye. In the fundus of the eye, water retention can often already be seen, a so-called “congestive papilla”. If there is a suspicion of increased intracranial pressure, this can be determined with the help of many test methods.
For this purpose, after drilling a hole in the skull, a measuring probe can be invasively inserted into various parts of the brain. This can permanently measure the pressure so that it can be read on a monitoring monitor. The invasive method always carries a risk of infection. Ultrasound examinations of the optic nerve can also offer an alternative to invasive measurements.
If there is a strong suspicion of increased intracranial pressure, a CT or MRI image can also be made immediately. Certain signs in the radiological picture indicate the increased pressure. If a tumor or other structural change in the skull is responsible for the pressure, it can also be diagnosed here.
The description of the symptoms by the patient, the examination of the fundus and the production of a CT or MRT image of the skull can provide good indications of the presence of increased intracranial pressure, but not an exact value for the intracranial pressure.
In some cases, e.g. To monitor the progress of a traumatic brain injury, however, doctors need an accurate measurement of the intracranial pressure. This can take the form of a brain probe, for example: After drilling a small hole in the skull, several small measuring probes are moved to different parts of the brain. Since this procedure always involves a certain risk of infection, it is reserved for emergencies. A gentler alternative is the ultrasound examination of the optic nerve, which however does not provide an exact value for the intracranial pressure either, but merely documents its effects on the nerve.
Read more on the subject here Measure intracranial pressure
Magnetic resonance tomography (MRT) is - like computed tomography of the head (CCT) - a possibility of diagnostic imaging in the case of increased intracranial pressure.
The advantages of the MRI over the CCT are the lack of radiation exposure and the better visibility of details of the brain, even if the examination duration is significantly longer in comparison.
In addition to the typical signs of increased intracranial pressure, causes for the increased intracranial pressure can also be identified, such as Bleeding or space-occupying processes (e.g. tumors in the brain).
Depending on the underlying cause of the increased intracranial pressure (e.g. Space-consuming process, cerebral edema, CSF outflow disturbance, etc.), different signs can be detected in the imaging in both the MRI and the CCT:
If the pressure is caused by a CSF outflow disorder, this can often be recognized on the basis of enlarged CSF spaces, whereas cerebral edema, on the other hand, is due to narrowed ventricles and CSF spaces as well as an elapsed surface relief of the brain.
Space-occupying processes can be detected on the basis of a shift in the center line or shifts or trapping of brain tissue.
Read more on the topic: MRI of the brain
Increased intracranial pressure can impair the functioning of the nerve responsible for constricting the pupil. Consequently, a dilation of the pupil is just as much a sign of intracranial pressure as a weakening of the so-called light reaction. The latter term describes the narrowing of the pupil as a result of irradiating the eye with a lamp. Both the width of the pupil and the light reaction are difficult to assess for inexperienced users, which is why a doctor should be consulted if anything is unclear and / or other symptoms are present.
Behind an increased intracranial pressure, which occurs especially in old age (also called age brain pressure; Frequency peak over 60 years) there is often an imbalance between nerve water production and nerve water absorption in the context of secondary or idiopathic normal pressure hydrocephalus.
Either too little nerve water is then absorbed back into the blood from the brain chambers or the body produces too much of it.
This occurrence leads to symptoms that appear very suddenly and often a triad of gait disorders or gait insecurities, memory difficulties and one Urinary incontinence represent.
However, these symptoms in old age do not always immediately lead to thinking of old age cerebral pressure, but above all of beginning ones Parkinson's- or Dementiaso that the old age brain pressure can often be easily overlooked. In contrast to these diseases, however, the cerebral pressure of old age or normal pressure hydrocephalus can be cured by correcting the increase in intracranial pressure in good time.
Increases in intracranial pressure can often occur in infants. Normal development processes, the stress caused by the birth process, the “water head in the baby” or an open back can be responsible for this. It is important to recognize the signs and symptoms early on and interpret them correctly, even in babies.
Initially, there may be vomiting, restlessness and tearfulness.Increased nervousness and sensitivity to touch are also typical. The “sunset phenomenon” can often be seen. The child's eyeball rolls down a lot, so that the iris disappears and can only be seen white in the eyes. Since the head is still growing, bulging of the open cranial sutures ("fontanelles") and an enlargement of the head can be determined.
Read more on the topic: Therapy of the water head
Increased intracranial pressure in children is often associated with hydrocephalus (Expansion of the fluid spaces / ventricles of the brain filled with nerve water) which can be either congenital or acquired. Congenital hydrocephalus is usually present in the womb or at birth and is often due to a genetic abnormality, malformations of the bony skull, the fluid spaces or the brain itself, all of which can lead to a drainage disorder of the nerve fluid.
The causes that lead to acquired hydrocephalus include infections (e.g. toxoplasmosis), inflammation of the brain or meninges, cerebral haemorrhage, brain tumors, previous trauma or operations on the brain.
What is particularly important about increased intracranial pressure in children is that characteristic deformation of the skull can occur if this occurs before the cranial sutures and fontanelles have closed or fused together.
Read more on the topic: Therapy of the water head
The early detection of increased intracranial pressure in children can be very difficult for parents, as children are often not yet able to clearly formulate and localize their symptoms. If the child reports headache and nausea and / or suffers from vomiting, other causes are usually more likely (especially flu infection, gastrointestinal infection), but increased intracranial pressure should at least be kept in mind. In this context, the absence of fever suggests an increase in intracranial pressure and against an infectious cause.
Ophthalmoscopy (fundus mirroring) plays an important role in medical diagnostics, but is not suitable for parental recognition of increased intracranial pressure, since intracranial pressure signs develop over a longer period of time and can only be recognized with the help of special examination equipment. Parents should be alarmed if they notice a certain apathy or apathy in their child, particularly with very young children who are not yet able to express their complaints verbally. In case of doubt, a doctor should always be consulted immediately, as long-term increased intracranial pressure, especially in children, can lead to lasting impairment of brain development.
A brain tumor can lead to increased intracranial pressure. It does not matter whether the tumor is benign or malignant. The problem with this is the tumor itself, which penetrates into the so-called “liquor spaces” that house the cerebral fluid. The liquor spaces are subject to a cycle in which new fluid is constantly produced and the old fluid can flow off in a certain direction. If this drainage is blocked by a large tumor, the pressure in the brain increases.
In the long term, an operation is the only sustainable measure to remedy the increased intracranial pressure in these cases.
The increase in intracranial pressure is one of the most common sequelae after a stroke.
The increased intracranial pressure is caused by water retention (Edema) into the areas of the brain affected by the stroke and damaged as a result, much like a sprained ankle or twisted knee swells. For this reason, patients should be monitored by means of monitoring in the first days after a stroke; in the case of very pronounced strokes, it may even be necessary to uncover (remove a piece from the skull bone) in order to relieve the brain.
There are two essential connections between blood pressure and intracranial pressure: First, blood pressure influences intracranial pressure insofar as increased blood pressure also leads to increased intracranial pressure. This is because the liquor, which is largely responsible for intracranial pressure, is generated from the blood by filtration. If the blood pressure rises, more blood is filtered and more liquor is produced, and the intracranial pressure rises. Patients with a known increase in intracranial pressure should therefore place particular emphasis on normal blood pressure.
A second interaction between blood pressure and intracranial pressure is as follows: In order for the blood to find its way from the heart to the brain, the intracranial pressure must necessarily be lower than the blood pressure (liquids always move from the place of higher pressure to the place of lower pressure). This fact is one of the main reasons why increased intracranial pressure can be so dangerous and urgently requires medical treatment.
As a rule, a lumbar puncture is contraindicated if there is an increase in intracranial pressure, i.e. it shouldn't be done. For the following reason: As part of the lumbar puncture, the cerebral fluid is drained from the liquor space (the chamber surrounding the brain and spinal cord in which the cerebral fluid is located) of the spinal cord, the brain shifts down towards the spinal cord. While this is not a problem in a healthy patient without increased intracranial pressure, the combination of increased intracranial pressure and lumbar puncture harbors the risk of the brainstem being trapped by penetrating into the large cranial opening from above (Foramen magnum) urgent brain.
Such entrapment is absolutely life-threatening, which explains the contraindication of a lumbar puncture in the case of increased intracranial pressure. The only exception to this rule is suspected idiopathic intracranial hypertension (Pseudotumor cerebri). But even in this case, before the lumbar puncture, it must be ensured with the aid of a CT scan that the triggering of entrapment by the lumbar puncture is practically impossible.
Read more on the subject at: Lumbar puncture
An intracranial pressure probe is mainly used for severe head trauma or other diseases (e.g. tumor, pronounced stroke) with a significant increase in intracranial pressure for precise measurement and monitoring of intracranial pressure.
In this way, it should be recognized at an early stage if the increased intracranial pressure causes parts of the brain to become trapped in the cerebellar tent (Tentorium) or in the large opening of the skull (Foramen magnum) emerges. In addition, too high intracranial pressure can impair blood flow to the brain.
To place a brain probe, a small hole (about 0.5 cm in diameter) is first drilled in the skull, through which the brain probe can then be inserted. As a rule, several measuring probes are placed in order to be able to measure the pressure in different compartments of the brain. Since the installation of an intracranial pressure probe is an invasive procedure and therefore harbors a certain risk of infection, its use is reserved for particularly urgent cases, but unfortunately sometimes indispensable.
Increased intracranial pressure
An overview of allhe images by Dr-Gumpert can be found at: medical illustrations
