Intracranial Hypertension

Intracranial hypertension (IH) is a medical condition characterized by elevated intracranial pressure (ICP), which refers to the pressure within the cranial cavity. The normal ICP range is between 5-15 mmHg, and pressures above this range can be considered abnormal.

Causes

• Traumatic brain injury: Head trauma can cause bleeding or swelling in the brain, leading to increased ICP.
• Brain tumors: Tumors can occupy space within the cranial cavity and increase pressure on surrounding brain tissue.
• Hydrocephalus: A condition characterized by an accumulation of cerebrospinal fluid (CSF) in the brain, leading to increased ICP.
• Meningitis and encephalitis: Infections that cause inflammation of the meninges or brain tissue can increase ICP.
• Idiopathic intracranial hypertension (IIH): A condition characterized by elevated ICP without a clear underlying cause, often associated with obesity and female sex.

Symptoms

• Headache: Often described as severe, worsening in the morning, and improving throughout the day.
• Nausea and vomiting: May occur due to increased ICP and brainstem compression.
• Visual disturbances: Blurred vision, double vision, or loss of peripheral vision can occur due to increased pressure on the optic nerve.
• Papilledema: Swelling of the optic disc, which can be detected during a fundoscopic examination.
• Tinnitus and hearing loss: May occur due to increased pressure on the auditory nerve.

Diagnosis

• Neurological examination: A thorough evaluation of neurological function, including assessment of mental status, cranial nerves, and motor function.
• Imaging studies: Computed tomography (CT) or magnetic resonance imaging (MRI) scans to visualize the brain and detect any abnormalities.
• Lumbar puncture (LP): A procedure to measure CSF pressure and analyze CSF composition.
• Intracranial pressure monitoring: Direct measurement of ICP using an intraventricular catheter or a subdural bolt.

Treatment

• Medications: Diuretics, such as acetazolamide, to reduce CSF production and decrease ICP.
• Surgical interventions: Shunting procedures to divert excess CSF from the brain to other parts of the body, or surgical decompression to relieve pressure on the brain.
• Monitoring and management: Close monitoring of ICP, vital signs, and neurological function in an intensive care unit (ICU) setting.

Complications

• Visual loss: Permanent vision loss can occur if papilledema is left untreated or if optic nerve damage occurs.
• Cognitive impairment: Chronic elevated ICP can lead to cognitive decline and memory problems.
• Seizures: Increased ICP can increase the risk of seizures, particularly in patients with a history of seizure disorders.

Prognosis

The prognosis for intracranial hypertension depends on the underlying cause, severity of symptoms, and effectiveness of treatment. With prompt and appropriate management, many patients can experience significant improvement or resolution of symptoms. However, some cases may be refractory to treatment, leading to chronic disability or increased risk of complications.