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INTRACRANIAL PRESSURE: CAUSES, SYMPTOMS, DIAGNOSIS AND
TREATMENT METHODS
Rahmatillayeva Yulduzxon Zafarbek qizi
Kokand University Andijan branch
Faculty of Medicine treatment direction
+998889751312
Scientific supervisor:
Razzaqov Nabijon Alijonovich
Abstract:
Intracranial pressure (ICP) is a pathological condition in which the pressure
inside the skull increases, significantly affecting brain function. The main causes of this
condition include hydrocephalus, brain tumors, head trauma, and intracranial hemorrhages.
The diagnosis of increased intracranial pressure is carried out through clinical examinations
and modern imaging techniques such as CT and MRI. Treatment involves diuretics, surgical
interventions, and supportive therapies. This article analyzes the various causes of
intracranial pressure, its pathophysiological mechanisms, and modern treatment approaches.
Keywords:
intracranial pressure, hydrocephalus, brain tumor, intracranial hemorrhage, head
trauma, diuretics, decompressive surgery
Аннотация
Внутричерепное давление (ВЧД) – это патологическое состояние, при
котором давление внутри черепа увеличивается, что существенно влияет на
функционирование мозга. Основные причины этого состояния включают
гидроцефалию, опухоли мозга, травмы головы и внутричерепные кровоизлияния.
Диагностика повышенного внутричерепного давления проводится с помощью
клинических осмотров и современных методов визуализации, таких как КТ и МРТ.
Лечение включает диуретики, хирургические вмешательства и поддерживающую
терапию. В данной статье рассматриваются различные причины внутричерепного
давления, его патофизиологические механизмы и современные методы лечения.
Ключевые слова:
внутричерепное давление, гидроцефалия, опухоль мозга,
внутричерепное кровоизлияние, травма головы, диуретики, декомпрессивная
хирургия
Intracranial pressure (ICP) is the force exerted by cerebrospinal fluid (CSF) and blood
within the skull. Under normal conditions, ICP in adults ranges from 7 to 15 mmHg (0.9-2
kPa). If this pressure exceeds 20 mmHg, it is considered dangerous and requires immediate
medical intervention. The skull is a closed cavity, and any increase in volume inside it leads
to brain compression, impaired blood circulation, and neuronal damage. Therefore,
understanding the causes, diagnosis, and treatment of increased intracranial pressure is of
great importance.
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I.
CAUSES
OF
INCREASED
INTRACRANIAL
PRESSURE
Intracranial pressure (ICP) is regulated by the balance between brain tissue volume,
cerebrospinal fluid (CSF), and cerebral blood flow. Any disturbance in this balance can lead
to an increase in ICP, causing significant neurological damage. The main causes of
increased
ICP
can
be
categorized
into
six
major
groups:
1. Increased Cerebrospinal Fluid Volume (Hydrocephalus) Hydrocephalus is a condition in
which cerebrospinal fluid accumulates excessively in the brain ventricles, leading to
increased intracranial pressure. The human brain produces about 500 mL of CSF per day,
with a normal circulating volume of about 150 mL at any given time. If CSF production
increases, absorption decreases, or its outflow is obstructed, hydrocephalus develops.
Types of Hydrocephalus
1. Communicating Hydrocephalus
Occurs when CSF absorption by the arachnoid villi is impaired.
Causes include meningitis, subarachnoid hemorrhage, and post-inflammatory scarring.
2. Non-communicating (Obstructive) Hydrocephalus
Occurs due to a physical blockage in the CSF pathways, preventing normal flow
Common causes include brain tumors, congenital malformations (e.g., aqueductal stenosis),
and cysts.
3. Normal Pressure Hydrocephalus (NPH)
A special form seen in elderly patients, characterized by gait disturbances, urinary
incontinence, and cognitive decline despite normal CSF pressure measurements.
4. Ex-vacuo Hydrocephalus
Results from brain atrophy where ventricular enlargement occurs as a compensatory
mechanism. Seen in Alzheimer’s disease and other neurodegenerative conditions.
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2. Brain tumors
Brain tumors, whether benign or malignant, can cause increased ICP by
occupying space within the rigid cranial vault. The global incidence of primary brain tumors
is around 10 per 100,000 people per year, with gliomas and meningiomas being the most
common.
Mechanisms
of
ICP
increase
due
to
tumors
Direct compression of brain tissue and ventricles, leading to obstruction of CSF pathways.
Induced
cerebral
edema
due
to
tumor-induced
inflammation.
Tumor hemorrhage, which can further exacerbate pressure. Increased vascular permeability,
causing fluid leakage into the brain parenchyma. Tumors in critical locations, such as the
posterior fossa or third ventricle, are particularly dangerous due to their ability to rapidly
increase
ICP.
3. Intracranial Hemorrhages
Intracranial hemorrhages cause rapid and often life-
threatening increases in ICP due to the accumulation of blood within the brain or its
surrounding spaces.
Types of Hemorrhages leading to increased ICP
1. Epidural Hematoma
Usually caused by trauma leading to rupture of the middle meningeal artery.
Symptoms include a lucid interval followed by rapid neurological deterioration.
2. Subdural Hematoma
Caused by rupture of bridging veins, common in elderly patients or those with coagulation
disorders.
Often develops slowly over days or weeks.
3. Subarachnoid Hemorrhage (SAH)
Most commonly due to ruptured aneurysms (e.g., Berry aneurysms). Presents with sudden
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"thunderclap" headache, photophobia, and loss of consciousness.
4. Intracerebral Hemorrhage (ICH) Occurs due to hypertensive damage to deep penetrating
arteries. Common in locations such as the basal ganglia, thalamus, and pons. Each of these
hemorrhages can lead to brain herniation, a deadly complication in which brain structures
shift due to extreme pressure differences.5. Brain Infections and Inflammation
Infections affecting the brain can cause significant swelling and inflammation, leading to
increased ICP.
Common Infectious Causes of Elevated ICP
1. Meningitis
Bacterial meningitis (e.g., Neisseria meningitidis, Streptococcus pneumoniae) leads to
thickened CSF, impairing absorption. Viral meningitis generally has a lower risk of ICP
elevation but can still cause complications.
2. Encephalitis Caused by viruses such as Herpes simplex virus (HSV-1), West Nile virus,
and rabies.
Leads to widespread brain inflammation and necrosis.
3. Brain abscess
Localized collection of pus within the brain, usually due to bacterial or fungal infections.
Can compress brain tissue and block CSF flow, causing acute increases in ICP. Brain
infections can be particularly dangerous in immunocompromised individuals (e.g.,
HIV/AIDS, post-transplant patients).
6. Severe Hypertension and Cerebral Venous Thrombosis Chronic hypertension and venous
circulation disorders can also contribute to increased ICP.
1. Hypertensive encephalopathy . A result of severe, uncontrolled high blood pressure
leading to cerebral edema.
Presents with headache, vision changes, and confusion.
2. Cerebral venous sinus Thrombosis (CVST) A rare but serious condition where blood clots
form in the brain's venous system. Leads to venous congestion, cerebral edema, and
increased ICP. Risk factors for CVST include pregnancy, oral contraceptives, malignancy,
and dehydration.
Increased intracranial pressure is a complex condition with multiple potential causes,
ranging from CSF dysregulation to traumatic injuries and systemic diseases. Each cause
requires a specific diagnostic approach and tailored treatment strategy. Understanding the
underlying mechanisms of ICP elevation is crucial for early intervention and improved
patient outcomes.
II. PATHOPHYSIOLOGY OF INTRACRANIAL PRESSURE
According to the Monro-Kellie doctrine, the intracranial cavity has a fixed volume. Any
increase in brain tissue, blood, or CSF volume raises ICP. This, in turn, affects cerebral
blood flow and oxygen supply to neurons. If ICP remains elevated for a prolonged period,
neurons may die due to ischemia. In severe cases, brain herniation can occur, which is a life-
threatening emergency.
III. MAIN SYMPTOMS OF INCREASED INTRACRANIAL PRESSURE
The clinical presentation of increased ICP includes: Severe headaches, especially in the
morning
,
Sudden vomiting without nausea
,
Visual disturbances (double vision, papilledema)
Altered mental status (drowsiness, confusion, or loss of consciousness) Bradycardia and
hypertension (Cushing's triad),Seizures
IV. DIAGNOSTIC METHODS FOR INTRACRANIAL PRESSURE
Intracranial pressure is assessed using the following diagnostic techniques:
Clinical examination
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Neurological evaluation and fundoscopy to check for papilledema.
Imaging studies
.
CT (Computed Tomography) → Identifies hemorrhages, tumors, and
hydrocephalus. MRI (Magnetic Resonance Imaging) → Detects cerebral edema and
structural abnormalities.
Direct ICP monitoring
.
Involves placing a catheter into the brain to measure pressure
directly.
V. TREATMENT METHODS
1. Pharmacological treatment
Diuretics (mannitol, furosemide) → Reduce CSF volume and lower ICP.
Corticosteroids (dexamethasone) → Reduce cerebral edema, especially in brain tumors.
2. Surgical interventions
Decompressive craniotomy – A portion of the skull is removed to reduce pressure.
Ventriculoperitoneal shunt – Used in hydrocephalus to drain excess CSF.
3. Supportive therapy
:
Mechanical ventilation to regulate CO₂ levels
.
Keeping the head
elevated at a 30° angle to improve venous drainage
CONCLUSION
Increased intracranial pressure is a serious medical condition that requires prompt diagnosis
and treatment. Modern imaging techniques (CT, MRI) allow for rapid and accurate
assessment. Advances in pharmacology and neurosurgical technology offer promising
treatment
options
for
better
patient
outcomes.
Future
research
should focus on emerging neuroprotective strategies to improve management and prognosis.
Increased intracranial pressure (ICP) is a serious condition that can severely impact brain
function and even lead to death if not managed promptly. The causes of increased ICP are
diverse, ranging from hydrocephalus and brain tumors to traumatic injuries and infections.
Understanding the underlying mechanisms of ICP elevation is essential for accurate
diagnosis and effective treatment. Modern diagnostic techniques, such as CT and MRI,
provide valuable insights into the underlying causes of ICP and allow for timely
interventions. Pharmacological treatments, including diuretics and corticosteroids, can help
manage the condition, while surgical interventions, such as decompressive craniotomy and
ventriculoperitoneal shunting, can alleviate pressure and prevent further damage. Effective
management of increased ICP requires a multidisciplinary approach, combining
pharmacology, surgery, and supportive care. Ongoing research into neuroprotective
strategies holds promise for improving patient outcomes and reducing the long-term impact
of elevated ICP. Early recognition and intervention are crucial in minimizing the risk of
permanent brain damage and optimizing recovery.
REFERENCES
1. Adams R.D., Victor M., Ropper A.H. Principles of Neurology. McGraw-Hill, 2014.
2.
Greenberg
M.S.
Handbook
of
Neurosurgery.
Thieme,
2020.
3. Guyton A.C., Hall J.E. Textbook of Medical Physiology. Elsevier, 2016.
4. Goadsby P.J., et al. "Intracranial Pressure and Headache." Lancet Neurology, 2017.
5. De Luca G.C., et al. "Raised Intracranial Pressure: Pathophysiology, Diagnosis, and
Treatment." Neurology, 2018.
