What Is Increased Intracranial Pressure?
The normal pressure maintained inside the brain is five to fifteen millimeters of mercury. When it goes beyond twenty millimeters of mercury, we call it increased intracranial pressure (ICP). It is a dangerous condition that requires emergency medical care. As the pressure inside the skull keeps increasing beyond a certain level, it may damage the brain and spinal cord. Hence, one should do the needful to relieve the pressure and control the underlying cause at the earliest to minimize the level of damage.
What Are the Causes of Increased Intracranial Pressure?
The brain and spinal cord lay suspended in a pool of clear fluid known as the cerebrospinal fluid (CSF). Any inflammation in the brain or surrounding layers causes an increase in fluid production. This raises internal pressure on the brain. Bleeding into the brain also elevates pressure. The most common causes are:
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Hydrocephalus, where the cerebrospinal fluid keeps increasing in quantity and gets collected inside the brain.
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Blood pooling inside the brain (intraventricular hemorrhage) due to head trauma, aneurysm (ballooning of blood vessels), rupture, or a stroke.
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Bleeding within the space between the brain and its outer covering (subdural hematoma) or the space between the outer covering of the brain and the skull (epidural hematoma).
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High blood pressure may cause spontaneous bleeding inside the brain (hypertensive brain hemorrhage).
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Tumors inside the brain.
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Infections in the brain (encephalitis) or its outer covering (meningitis) can cause irritation, inflammation, and brain swelling.
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Formation of massive blood clots in the veins of the brain.
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Injuries in the brain following a heart attack or seizure may also increase intracranial pressure.
What Are the Symptoms Indicating Increased Cranial Pressure?
A severe headache is the most common symptom. Along with that, one may suffer several neurological symptoms as well, which are:
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Problems with eyesight such as blurry vision, dark patches in front of the eyes (blind spots), seeing two of every object (double vision), inability to see things on the sides (peripheral vision), and going blind temporarily.
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Mental confusion and changes in behavior.
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Increase in blood pressure.
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Vomiting.
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Shallow breathing.
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Feel fatigued and sleepful.
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Weakness in body parts.
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Trouble walking and moving around.
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Restlessness and agitation.
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In babies, one may notice a bulge on top of the head and severe vomiting.
What Are the Complications From Increased Intracranial Pressure?
Beyond a certain level, the rise in intracranial pressure starts to compress the brain and spinal cord, damaging their important structures. Additionally, this restricts proper blood flow into various parts of the brain. In advanced stages, increased intracranial pressure leaves the individual unresponsive with fixed dilated pupils. Eventually, one may suffer a stroke, seizures, and massive nerve cell damage leading to permanent disabilities or death.
How Is an Increased Intracranial Pressure Diagnosed?
As the symptoms progress rather fast, in the majority of cases, the doctor will see the affected person in the emergency room. If the event of head injury is a motor vehicle accident, sports injury, physical abuse, or fall, the doctor needs to know all the details about it. This helps one predict the possibility of rising intracranial pressure. The doctor will review the medical history and the family’s health background. A physical examination will be conducted, followed by further diagnostic studies, which are:
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Glasgow Coma Scale - To evaluate the mental state, responsiveness, and eye symptoms of the affected individual (level of consciousness). In events like a head injury, a change in score may be indicative of pressure build-up inside the head.
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Neurological Examination - Where the doctor will evaluate the brain function by testing the senses, mental status, and balancing ability.
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Eye Examination - With an ophthalmoscope, one can tell if there are signs of increased intracranial pressure. One may notice dilated nonmoving pupils, droopy eyelids, unclear eyesight, double vision, and a swollen optic nerve.
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Lumbar Puncture - Also called a spinal tapping procedure, where the doctor inserts a needle into the lower back area of the spine to measure the pressure of the cerebrospinal fluid. One may insert a tube (catheter) into the fluid-filled space inside the brain (ventricular space) to monitor the pressure.
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Computed Tomography (CT) Scan - Of the head and brain gives a series of X-ray images that gives a detailed view of the underlying cause of increased intracranial pressure.
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Magnetic Resonance Imaging (MRI) - Gives an even more detailed view of every section of the brain. One may identify the apparent changes inside the brain due to increased intracranial pressure and its underlying cause.
What Is the Management Strategy for Increased Intracranial Pressure?
The affected individual should be rushed to the hospital for urgent care and kept under a mechanical life support system. The health care team will monitor the heart rate, breathing, blood pressure, body temperature, and blood oxygen levels and do the needful to keep them regulated. The immediate course of action is to reduce intracranial pressure. For this, the doctor may:
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Prescribe medicines to reduce the swelling. Mannitol and Hypertonic saline are found useful. Doctors also prescribe anti-anxiety drugs to reduce agitation and other nervous responses.
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Keep the head elevated at a thirty-degree ankle for draining the fluid through veins.
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One might drill a hole into the skull to place a rubber tube known as brain shunt to create a vent for the blood or fluid to drain.
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Keep monitoring the pressure with an intracranial pressure monitor to regulate the dosage of medicine.
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Secondly, the doctor will attend to the underlying cause for the increase in intracranial pressure, which includes treating an infection, high blood pressure, tumor, or stroke. The doctor may perform surgery to remove a small part of the skull (craniotomy) to have more room for the brain to expand.
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Cooling the body (therapeutic hypothermia) also helps reduce excess intracranial pressure.
Conclusion
One may prevent an event of increased intracranial pressure by avoiding traumas and certain other health issues. Lifestyle improvements, including body weight maintenance, regular exercising, and eating healthy, can potentially lower the risk of stroke and high blood pressure. Getting vaccinated against infections that affect the head can also reduce the risk. Sports injuries and automobile accidents are the major reason for head trauma. Wearing a helmet and seatbelt prevent injuries to a great extent. And in the event of trauma, if one notices persisting headaches, vision problems, seizures, or behavior changes, do seek medical help at the earliest.
