Emergency treatment principles in intracranial hypertension

Abstract

As general principles the treatment of intracranial hypertension depends on the type of intracranial hypertension and on the stage of the illness. First the treatment is an etiologic one in order to remove the cause that has caused the intracranial pressure increase: intracranial masses producing elevated ICP should be removed when possible. Simultaneously, there is an attempt to stop the pathogenic mechanisms that impact on the nervous structures, and a symptomatic treatment is applied in order to reduce the intensity of the clinical syndrome. In the case of a patient with a suspicion of decompensating intracranial hypertension, one must perform and assess: • the complete evaluation of the patient with the acute ICH syndrome: one must assess the consciousness level, the conscience state, the aspect of the pupils must be monitored and the Glasgow score must be established, • the vital conditions: free aerial ways, respiration and the circulatory function; resuscitation operations are performed if needed, with oro-tracheal intubation, etc. In case of traumatisms, a cervical vertebralmedullar lesion must be excluded, and possible lesions with a vital risk must be revealed if they require an immediate solution. • the emergency exploration by a cranial-cerebral computer tomography establishes the diagnosis and the therapeutic option is decided. (2, 8, 12, 14, 16, 30) Thus the first therapeutic actions are determined depending on the lesional characteristics: the expansive intracranial process (tumor, traumatic process), which has induced the ICH syndrome is surgically extirpated in order to remove the supplementary pathogenic volume with a compressive effect (mass effect), and which leads to a brain edema. the expansive intracranial process that blocks the CSF circulation paths with the production of an obstructive hydrocephalus and the ICH syndrome requires at first the performance of a ventricular drainage and then, based on the characteristics of the lesion, there will be an intervention for its extirpation. in the blood blockage of the ventricular system in intracranial hemorrhages, with the occurrence of the ICH syndrome due to obstructive hydrocephalus, the ventricular drainage is performed, and then the exploration and the treatment of the intracranial hemorrhage. the presence of a brain edema without any other lesion requires the antiedematous treatment in order to reduce the intracranial pressure, at the same time as maintaining the a cerebral perfusion pressure within normal limits by the