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1、IntracranialHypertensionGeneY.Sung,M.D.,M.P.H.Director,NeurocriticalCareandStrokeDivisionUniversityofSouthernCaliforniaIntracranialPressurePhysiologyMonro-KellieDoctrine(1783/1824)1.Rigidcontainer2.Liquidcontentsareincompressible3.MassmustbedisplacedIntracranialPressurePhysio
2、logyCranialContentsTotalVolume1300-1500ccBrain~80%graymatter/whitematterCSF~10%Intraventricular50%75ccSubarachnoid50%75ccBlood~10%Arterial30%45ccVenous70%105ccIntracranialPressurePathophysiologyBlood–epidural,subdural,subarachnoid,intracerebral,intraventricular,intravascularT
3、umorAbscess/InfectionForeignObjectsAir–pneumocephalusCranialRestriction–Paget’sdisease,craniosynostosisHydrocephalus,Cysts,HygromaEdemaInterstitial–e.g.CNSlymphsystem,brainasaspongeCytotoxic–dead/dyingcellsVasogenic–alteredBBB,capillarybreakdown,abscessIntracranialPressurePat
4、hophysiologyMassDisplacementCSFBloodBrainICP/CPP150125100755025002550CerebralPerfusionPressure(mmHg))CerebralBloodFlow(ml/100g/min)ZoneofNormalAutoregulationMaximumConstrictionMaximumDilatationPassiveCollapse02550ICP(mmHg)VasodilatoryCascadeZoneAutoregulationBreakthroughZoneS
5、tephanA.Mayer,MDIntracranialPressurePhysiologyIntracranialPressurePathophysiologyHerniationTypesStructureBarrierVesselSubfalcinecingulateg.falxACAUncaluncustentoriumPCATonsillarcerebellumforamenm.vert/bUpwardcerebellumtentoriumTranscalvarialcortexskullsurfaceIntracranialPress
6、urePathophysiologyHerniationTypesSubfalcineUncaltonsillarIntracranialPressurePathophysiologyElevatedICPClinicalSymptomsHeadache-Aggravatedbybendingandstooping.Causedbydistortionorirritationofpainsensitiveareasintheduralcoveringsandbloodvessels.Vomiting-Causedbycompressionoris
7、chemiaofbrainstem.Usuallyoccurswithlesionsoftheposteriorfossa.Thisisusuallytheresultofhydrocephalusand4thventricledilationcausingstimulationofthenucleusofvagusnerve.Personalityandbehaviorchanges- Adepressioninmotorandthoughtprocessesthatcanleadtosomnolence,anddecreasedlevelo
8、fconsciousnessandcoma.Causedbycompressiononthereticularsubstanceofup
