Abstract
Background: Although the effects of opioids on intracranial pressure (ICP) have long been a subject of controversy, they are frequently administered to patients with severe head trauma. We present a patient with an uncommon paradoxical response to opioids.Case Report: A patient with refractory intracranial hypertension after closed head injury was managed with standard medical therapy with only transient decreases in the ICP. Only after discontinuation of opiates did the ICP become manageable without metabolic suppression and rescue osmotic therapy, implicating opiates as the etiology of refractory intracranial hypertension in this patient.Conclusion: Clinicians should consider opioids as a contributing factor in malignant intracranial hypertension when findings on neuroimaging do not explain persistent and refractory intracranial hypertension.
Highlights
Opioids frequently are administered to patients with severe head trauma, the effects of such drugs on intracranial pressure (ICP) are controversial (Marx et al, 1989; Cuillerier et al, 1990; Weinstabl et al, 1991; Markovitz et al, 1992)
Background: the effects of opioids on intracranial pressure (ICP) have long been a subject of controversy, they are frequently administered to patients with severe head trauma
The decrease in mean arterial blood pressure (MAP) has been hypothesized to be the mechanism of increased ICP observed after administration of opioids in patients with reduced intracranial compliance and intact autoregulation through a pathway of vasodilation and increased blood volume (Werner et al, 1995)
Summary
The effects of opioids on intracranial pressure (ICP) have long been a subject of controversy, they are frequently administered to patients with severe head trauma. We present a patient with an uncommon paradoxical response to opioids. Case Report: A patient with refractory intracranial hypertension after closed head injury was managed with standard medical therapy with only transient decreases in the ICP. After discontinuation of opiates did the ICP become manageable without metabolic suppression and rescue osmotic therapy, implicating opiates as the etiology of refractory intracranial hypertension in this patient
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