Intracranial Hypertension

By on September 1, 2012 with No Comments

Intracranial hypertension- IH is a neurological disorder in which there is increased cerebrospinal fluid pressure in the skull. Other terms which were previously used to refer to intracranial hypertension are benign intracranial hypertension and pseudotumor cerebri. The condition is characterized by increased intracranial pressure around the brain without any tumor or other disease.

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Causes of intracranial hypertension

Idiopathic intracranial hypertension has no known etiology meaning that there is no identifiable cause of the condition. The intracranial pressure may increase as a result of medication like high dosage of vitamin A derivatives such as isotretinoin used for the treatment of acne. When a person engages in a long term use of antibiotics such as tetracycline that are used to treat skin conditions, this may also lead to increase pressure in the brain.

Use of corticosteroid, hormonal contraceptives and cyclosporine are also other associated causes of intracranial hypertension. There are other disease conditions which are linked to intracranial hypertension and these are such as obstructive sleep apnea, systemic lupus erythematosis and chronic kidney disease.

When there is known cause of intracranial hypertension, it is referred to as secondary intracranial hypertension. There has been discovery of idiopathic intracranial hypertension among patients who have narrowing of veins that originate from the back of the brain, a condition called venous sinus thrombosis.

Pathogenesis of intracranial pressure

Although there is no known cause for idiopathic intracranial hypertension, the pressure in the skull is determined by the amount of brain tissue and the cerebrospinal fluid. It is also determined by the blood in the bony cranial vault. The Monro-Kellie rule tries to examine the interrelation of these factors and how they contribute to the disorder.

When there is excess of cerebrospinal fluid and the volume of blood or brain tissue is increased, these may raise the idiopathic blood pressure in the intracranial part of the brain. In addition, obstruction of the veins that drain blood from the brain may also lead to this condition. Although there is little evidence, which supports these factors, experimental and examination in both biopsy samples and various brain scans have shown that increased water content in the brain tissue can lead to elevated blood pressure.

When there is impairment of blood flow from the brain and the vessels are congested, this may also lead to narrowed vessels, which can create pressure on the vascular wall tissues. Similarly, only a small percentage of patients with narrowed cerebral sinuses or veins have shown an increased blood pressure leading to idiopathic intracranial hypertension.

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Symptoms of Intracranial Hypertension 

The symptoms of intracranial hypertension depend on whether it is idiopathic or secondary. Idiopathic intracranial hypertension is characterized by headache, which is said to occur in 92-94% of all cases. The headache is worse in the morning and is frontal or affects the forehead. In addition, the headache is throbbing in nature and this causes a lot of discomfort.

Any activity which increases intracranial pressure such as coughing and sneezing may worsen the headache. Other symptoms are pain in the neck and shoulders. Moreover, many patients experience pulsatile tinnitus, which is a whooshing sensation in the ears. The sound synchronizes with the pulse rate of the heart.

Other signs are such as numbness of extremities. A patient may lose the sense of smell and also experience general body weakness. Double vision may also be a sign of the disorder. Transient visual obstructions may occur in patients with the condition.

Intracranial Hypertension Treatment

The treatment of idiopathic intracranial pressure is aimed at relieving some of the visual loss and blindness and other symptoms’ control. Reduction of cerebrospinal fluid is another treatment, which is done to reduce the pressure. Weight loss may also be done to reduce weight, which is also associated with the condition. The best studied medical treatment for IH is acetazolamide or Diamox, which is an inhibitor for the enzymes carbonic anhydrase.

The medication is said to bring down the synthesis of cerebrospinal fluid by about 6 to 57 %. However, this medication cannot be used in pregnant mothers. Diuretic furosemide is at times used if the acetazolamide is not tolerated by the patient. Various painkillers such as analgesics are also used in controlling the headache. In extreme cases, surgical procedures may be applied.

There are two main surgeries that can be performed in treating intracranial hypertension and these are optic nerves health decompression and fenestration as well as shunting. Surgery is opted when other therapies do not yield any results in managing the disorder. The surgery procedure adopted depends on the predominance of the blood pressure.

Optic nerve sheath fenestration is a procedure, which makes an incision in the connective tissue lining of the optic nerve. One thing with the surgical procedure used in treating idiopathic intracranial hypertension is that they can result to complications. The sheath fenestration procedure could lead to blindness and 1-2% cases have been reported in patients who are operated with this procedure.

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Category: Intercranial Hypertension

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