Cerebral pressure elevation can be life-threatening and requires urgent medical intervention in severe cases. Causes of the syndrome may include skull injury and chronic or acute illness. Without treatment, there is a risk of permanent brain damage from intracranial pressure elevation.
What is intracranial pressure elevation?
An intracranial pressure elevation means an increase in the pressure prevailing inside the skull above the physiological normal value. Because body tissue is a watery environment, this pressure can be described as hydrostatic pressure to a first approximation. Hydrostatic pressure is the pressure in a fluid. Increasing the amount of water in the brain can increase intracranial pressure because the volume of the brain is limited by the bony, rigid cranial capsule. The intracranial pressure can be practically equated with the intracranial pressure. The norm for intracranial pressure in healthy individuals is a value of 0 to 10 Torr. 1 Torr is the hydrostatic pressure of a 1 mm high mercury column (“mmHg”, Hg: chemical symbol for mercury). An intracranial pressure between 10 and 20 Torr indicates a slight increase in intracranial pressure; up to 30 Torr, the pressure increase is, by definition, moderate. Beyond that, physicians refer to severe or above 40 Torr as very severe intracranial pressure elevation.
Causes
Increased intracranial pressure occurs with injuries and various diseases. The increased intracranial pressure may be the result of a 3rd-degree traumatic brain injury (abbreviated SHT). This head injury, also called Compressio cerebri (brain compression), always leads to cerebral hemorrhage (hematoma) or cerebral edema (edema: accumulation of water in the body). Because of the increase in both types of fluid, intracranial pressure also increases. Cerebral hemorrhage in the course of a stroke is also due to these two factors. Increased intracranial pressure can also occur when tumors or abscesses develop in the brain and compress healthy tissue. Swelling of the meninges also increases intracranial pressure, as is the case with meningitis. But sunstroke is also a meningitis – in this case caused by UV radiation – and leads to an increase in intracranial pressure. Even cerebral edema causes the harmless-sounding syndrome resulting in an increase in intracranial pressure.
Symptoms, complaints, and signs
In the worst case, an increase in intracranial pressure can lead to the death of the affected person. However, this case usually occurs when the intracranial pressure elevation is left completely untreated. Patients primarily suffer from severe headaches in this disease. These can also spread to the ears or even to the back, where they also cause pain. The headaches are not infrequently accompanied by vomiting or nausea, with sufferers generally feeling ill and fatigued. Also, there is a slowed pulse and disturbances in consciousness. Tingling sensations and disturbances in blood flow occur, which can complicate the patient’s daily life. In many cases, the increase in intracranial pressure leads to paralysis of the eye muscles and thus to severe visual complaints or to complete blindness. In general, the increase in intracranial pressure leads to high blood pressure, which has a very negative effect on the health of the affected person. This can also lead to a heart attack, from which the affected person can die. If the disease is not treated, the affected person usually loses consciousness and then falls into a coma. Life expectancy is significantly limited and reduced with this disease.
Diagnosis and course
An increase in intracranial pressure produces symptoms such as headache, nausea to the point of vomiting, lassitude and dilated pupils, and bradycardia (slowed pulse). The doctor will ask about the history of these signs (accident, unconsciousness?) and inquire about other symptoms (stiff neck, fever in case of meningitis). It should be taken into account that the slower the increase in intracranial pressure developed, the weaker the symptoms. If the patient’s condition worsens, direct measurement of intracranial pressure may be required. In most cases, the affected person is then already unconscious or even in a coma. The physician inserts a special probe filled with physiological saline solution into the bored skull (trepanation).Without normalization of intracranial pressure, there is a risk of irreversible brain damage from increased intracranial pressure.
Complications
Increased intracranial pressure will cause the patient to die if left untreated. For this reason, the condition must be treated immediately by a physician. Severe damage to the brain continues to occur, which is irreversible and can lead to complications even after treatment. In most cases, those affected suffer primarily from severe headaches. These can also spread to other regions of the body and cause discomfort there. It is not uncommon for vomiting and nausea to occur as well. Patients suffer from a slow pulse and possibly loss of consciousness. Various symptoms may be caused by a fall. As a rule, the patient’s ability to cope with stress is also reduced and everyday life becomes very difficult. Visual disturbances may also occur. In severe cases, the patient falls into a coma. Treatment for increased intracranial pressure usually depends on the cause of the disease. In the case of a tumor, radiation therapy is usually used. If a stroke has led to the increase in intracranial pressure, treatment takes place with the help of medication. Complications do not occur. However, if treatment is too late, consequential damage can occur that is irreversible.
When should you go to the doctor?
Individuals who suddenly experience nonspecific headaches and a feeling of pressure around the head should see a doctor. If other symptoms such as nausea and vomiting or dizziness develop, medical advice should be sought immediately. Acute symptoms in the head and cardiovascular system indicate a serious condition that needs to be investigated and treated if necessary. An increase in intracranial pressure is also manifested by high blood pressure and eye muscle paralysis. If the above symptoms occur simultaneously, the sufferer must alert the emergency services. In severe cases, first aid measures must be administered until the emergency physician arrives. Subsequently, a longer hospital stay is usually indicated. An increase in intracranial pressure often occurs in conjunction with a traumatic brain injury. Abscesses in the brain, meningitis or sunstroke are also possible triggers. Anyone who belongs to these risk groups must consult a doctor immediately in the event of the above-mentioned signs. In addition to the family doctor, the cardiologist is the right contact person. In case of doubt, the affected person should be taken immediately to the nearest hospital.
Treatment and therapy
The physician will treat an increase in intracranial pressure by eliminating the respective cause. If a brain tumor is present, it will be surgically removed if possible. This is followed by chemotherapy or even radiation. After a stroke or craniocerebral trauma, doctors first exhaust all possibilities of drug treatment to alleviate an acute increase in intracranial pressure. Cortisone-like pharmaceuticals (glucocorticoids) also have a decongestant effect as anti-inflammatories. Parallel medication includes diuretics and osmotherapeutics. These are some types of sugar that cause a fluid shift in the tissue and drain the edematous volumes into the blood. In severe cases, intracranial pressure elevation must be addressed through minimally invasive or surgical techniques. Then the physician performs either ventricular drainage or, as a last resort, decromptive craniectomy. This involves removing sections of the skull, which lowers intracranial pressure. The neurosurgeons reinsert the bone fragments after the disease is over. Intensive medical monitoring is strictly mandatory, especially in severe cases of increased intracranial pressure.
Outlook and prognosis
The prospect of recovery in cases of intracranial pressure elevation is tied to the causative disease. If swelling occurs inside the head after an accident or fall, the intracranial pressure elevation is a result of the injuries. If no vessels or tissues were damaged, in many cases there is a gradual regression of the swelling within a few days, minimizing the increase in intracranial pressure. After a short time, the patient can be expected to recover completely and be free of symptoms. If tumor disease is present, the prognosis is unfavorable. Regardless of whether the tumor is benign or malignant, growth of the affected tissue leads to a further increase in intracranial pressure.Due to the closed shape of the skull, there are no escape routes for the tissue. This triggers a constriction inside the head and can lead to the bursting of various vessels and permanent tissue damage. This creates a life-threatening situation for the patient, which in severe cases results in premature death. In general, the longer the pressure persists and the higher it is, the worse the prognosis. In addition to a fatal outcome, the patient may suffer a comatose state or permanent dysfunction. Locomotor or cardiovascular dysfunction as well as respiratory dysfunction are the lifelong consequences.
Prevention
To counteract an increase in intracranial pressure in prophylaxis means to avoid the triggers. General measures of a healthy lifestyle can reduce the risk of a stroke, accidents are hardly calculable. Only the observance of appropriate safety guidelines – for example at the workplace – is to be recommended. In this context, the use of a bicycle helmet is recommended. Especially people in risk areas should consider a vaccination against meningitis. Against sunstroke, an appropriate head covering helps in midsummer and is thus a very simple measure also ultimately against an increase in intracranial pressure.
Aftercare
In most cases of an increase in intracranial pressure, the affected person has very few or even no measures and options for aftercare. In this case, the affected person is primarily dependent on a rapid and, above all, early diagnosis with subsequent treatment to prevent further deterioration of the symptoms. Self-healing does not occur with this disease, so the early diagnosis of the increased intracranial pressure is of primary importance. The treatment of increased intracranial pressure always depends on the exact cause and is usually performed by surgery or chemotherapy. The affected person must rest a lot and take care of his body during the therapy. Efforts or stressful and physical activities are to be avoided in order not to strain the body unnecessarily. In many cases, it is also necessary to take medication, whereby attention must be paid to the correct dosage. If there are any questions or uncertainties, a doctor should always be contacted first. Psychological treatment is also not infrequently necessary, whereby relatives or parents can also participate in this treatment. In most cases, the life expectancy of the affected person is significantly reduced due to the increase in intracranial pressure.
What you can do yourself
Cerebral palsy is a serious condition, so patients’ lives are in danger. Therefore, self-help measures alone do not do justice to the seriousness of intracranial pressure elevation and should be refrained from in any case until they have been discussed with a medical professional. In order to increase the personal chances of recovery, the patient, in his or her own interest, should contact a specialist as soon as possible. After the diagnosis and treatment plan, the patient is given the opportunity to positively influence the prognosis of the present intracranial pressure increase through certain behaviors. Although the symptoms are pronounced differently in each patient, in general they strongly affect the quality of life. It is therefore in the self-interest of the patient to reduce daily obligations and to allow himself a high degree of rest. Sports can usually no longer be performed to the usual extent, and certain types of sports should be avoided altogether. If the patient wishes to continue to engage in sports, this must be discussed with the attending physician in any case. The increase in intracranial pressure can be treated with medication and surgical interventions, whereby the affected patient basically adheres to all medical instructions.
