Prognosis
A general prognosis cannot be made for increased intracranial pressure due to the many possible causes. In the case of craniocerebral trauma, the extent of the increase in intracranial pressure and the time elapsed until treatment significantly influence the prognosis, which offers the complete spectrum from complete recovery within a few weeks to death. A similar range of prognosis exists for stroke.
Even if a tumor is the cause of the increased intracranial pressure, the prognosis is strongly dependent on the type and extent of the tumor and whether the tumor has already spread at the time of diagnosis. In the case of an inflammatory, toxic or stress-induced increase in intracranial pressure, however, the situation can often be improved by medication, thereby achieving complete or extensive freedom from symptoms. Depending on its severity, an increased ICP can sooner or later cause irreversible damage to the brain.
While an acute, strong increase in intracranial pressure, for example due to a craniocerebral trauma, can lead to a coma within a very short time and become life-threatening, an only slightly increased intracranial pressure develops its damaging effect on the brain over the course of several weeks or months. Therefore, increased intracranial pressure should always be treated immediately, regardless of its extent and cause! The impairment of the brain as a result of a long-term increase in intracranial pressure manifests itself, in addition to the above-mentioned symptoms (especially headaches, vomiting, nausea), in a reduced ability of the affected person to cope with everyday stress. Furthermore, visual disturbances can also occur: Due to the increased intracranial pressure, the optic nerve, which carries the visual information from the eye to the brain, is attacked. If no adequate therapy is carried out over a long period of time, further, more serious neurological limitations may result, such as movement disorders, deafness or speech disorders.
Therapy
If a patient has an increased intracranial pressure, he must always be monitored by intensive care medicine. The head must be positioned straight so that the flow of blood is not impeded. The patient should hyperventilate slightly, as this causes narrowing of the blood vessels, reduces blood flow and lowers the intracranial pressure.
The patient can be given diuretics to increase fluid excretion and thus reduce the cerebral edema. In addition to kidney diuretics, osmotic diuretics such as mannitol can be given. These draw water from the tissue into the blood and thus have a short-term decongesting effect, especially in critical brain edemas.In addition, the patient should be sedated, as sedation can reduce the metabolic needs of the brain.
This then lowers the blood flow to the brain, which has a lowering effect on the cerebral pressure. If the pressure is too high, it may be necessary to drain the cerebral fluid through an external ventricular drainage. A last resort may be a decompression craniectomy.
A puncture of the external cerebrospinal fluid spaces may be contraindicated, as there is a risk of cerebral constriction. According to new findings, hyperventilation is a therapeutic option for increased intracranial pressure in short-lasting crisis situations. In the case of severe increases in a short period of time, hyperventilation can make an important contribution due to its simple feasibility.
As the carbon dioxide is exhaled, the arterial vessels constrict, which leads to a slight drop in intracranial pressure. However, this effect lasts for only about 4-6 hours. Hyperventilation should by no means be the only therapy.
It is only effective as a support during rapid increases in pressure. There are no real home remedies for lowering increased intracranial pressure. A physician should always be consulted and his therapy guidelines followed.
Nevertheless, a few simple suggestions for everyday life can improve the well-being of patients with increased intracranial pressure: For example, raising the head by about 30° during the night is recommended (no more than that, otherwise you risk a reduced blood flow to the brain!) In addition, those affected should be shielded as much as possible from noise, bright light and psychological stress by their surroundings. In addition, care should be taken to ensure that the body temperature is not raised too much above the normal range of 36-37°C, as this can lead to increased blood circulation in the brain and thus to a further worsening of the increased cerebral pressure.
Monitoring of drinking and urine excretion quantities is also recommended: here, attention should be paid to a slightly negative or at least balanced balance, in order to “drain” the body, so to speak. As a rule, those affected initially complain of headaches and nausea, which is why they first consult their family doctor. If the family doctor finds indications of increased intracranial pressure based on the patient’s description, he or she will arrange for a referral to a neurologist or, in more urgent cases, an emergency hospital admission. Either way, the diagnosis and treatment of elevated ICP is the responsibility of the neurologist. Although the neurologist may consult an ophthalmologist for an eye examination (ophthalmoscopy), for example, and the evaluation of CT or MRI images is accompanied by a radiologist in any case, the neurologist is the treating physician and also the central contact person for follow-up examinations.