各论01-1颅内压增高脑疝

颅内压增高1编辑pptXinhuaSquare2编辑pptTrafficAccidents3编辑pptIraqWar4编辑ppt5编辑pptEmergencyRoomoftheAffiliatedHospital6编辑pptCraniocerebralinjuryhashighincidencewhetherinpeacetimeorwartimes.ButIncreasedICPistheessentialandtheknottyproblempassingthroughneurosurgicalclinicalandteachingwhichtheteachingprogrammedemandstohold.Importance

SignificanceNecessity7编辑pptIntracranialpressure,ICP：isthepressureincranialcavity,namelybrainpressure,whichisexpressedinpressureofCSF.Rangeofnormalvalue:0.7-2kPa

(70-200mmH2O),children:0.5-1.0kPa.>2kPaIntracranialhypertension，

<0.7kPaIntracranialhypotensionPathophysiology1.

PathophysiologyDEFINITION8编辑pptIntracranialthreecontentsPathophysiologyIt’sgeneralvolumeisconstant——1400ml9编辑pptGenerationofCSFPathophysiologytotalamount:130mlV=0.35ml/minAbsorptionOfCSF10编辑pptRegulationofICPPathophysiologyRelationtobloodpressure(BP)&respirationSystole—，Diastole—；Expiration—，Inspiration—ButitmainlydependsuponthechangeofvolumeofCSF.“Monroe-KelliePrinciple〞11编辑ppt

RegulationofICP

RelationtoCSF

TheabsorptivevelocityofCSFdependsuponthepressuredifferencebetweensubarachnoidspaceandvenoussinus.Ifexcessiveformation,obstructivecirculutionanddisturbancedabsorption

CSFvolumeBeyonditsregulationlevelintracranialpressurePathophysiology12编辑pptRegulationofICPRelationtoCBF(cerebralbloodflow)Braintissuerequiresmoreoxygenthanothertissues,soit’sthemostsensitivetohypoxiaandischemia.CBF=

Pathophysiologymeansystemicarterialpressure(mSAP)–ICPcerebralvascularresistance(CVR)cerebralperfusionpressure

(CPP)CVRRegulationofCBFislessthanofCSF,it’slimitedthattheabilityof“bulkcompensation〞toIntracranialhypertension=13编辑pptRegulationofICPPathophysiologyRelationtoBraintissueBraintissuehasalittleregulation.Chronic:compensatedbybraintissueatrophyandAmplificationofsubarachnoidspaceandventricles.Acute:can’tbecompressedobviously.14编辑ppt

2.Etiology

ExcessiveCSF：hydrocephalusCBF

：AVM、aneurysmsBraintissuevolume:cerebraledema(braininjury,inflammation,hypoxia,poisoning)Space-occupyinglesion：

hematoma,tumor,abscess,granulomaEtiologyBasilarinvaginationandlargedepressedfractureofskullcontentscranialcavity15编辑pptBrainInjuryNeurosurgeryMechanismofCloseCraniocerebralInjuryContusionandlacerationofbrain16编辑pptEpiduralHematomaNeurosurgery17编辑pptDepressedFractureNeurosurgery18编辑ppt3.Influencefatorsof

increasedintracranialpressure

Age：infant,senility

Course：acute,chronic

Langfitttestin1966:

volume/pressurecurve

Position：midline,posteriorfossa

Character：benign,malignant

Generalstate:

severesystemlesionInfluencefactors19编辑pptICP(mmH2O)Volume(ml)

VPRInfluencefactorsvolume/pressurecurve20编辑ppt3.Influencefatorsof

increasedintracranialpressure

Age：infant,senility

Course：acute,chronic

Langfitttestin1966:

volume/pressurecurve

Position：midline,posteriorfossa

Character：benign,malignant

Generalstate:

severesystemlesionInfluencefactors21编辑ppt

Consequences4.Consequencesof

increasedintracranialpressure

CerebralbloodflowHerniationofbrainCerebraledema:

ICPaffectingcerebralmetabolism&CBFcerebraledemaGastrointestinaldysfunctionPulmonaryedema

Cushingresponse

ICP

Bp,P,Pulsepressuredifference22编辑pptRegulationofICPRelationtoCBF(cerebralbloodflow)CBF=

Pathophysiologymeansystemicarterialpressure(mSAP)–ICPcerebralvascularresistance(CVR)cerebralperfusionpressure

(CPP)CVR=23编辑ppt

Consequences4.Consequencesof

increasedintracranialpressure

CerebralbloodflowHerniationofbrainCerebraledema:

ICPaffectingcerebralmetabolism&CBFcerebraledemaGastrointestinaldysfunctionPulmonaryedema

Cushingresponse

ICP

Bp,P,Pulsepressuredifference24编辑ppt

5.ClinicalmanifestationsofincreasedICPHeadacheVomitingPapilledemaOthersymptomsChangesofvitalsignsHerniationofbrainClinicalmanifestation25编辑ppt

Headache

Thecommonnestsymptomwhichoftenarisesatmorningoreveningandwithforwardradiationtoorbit,aggravatedwithincreasedICP.Theheadachecanincreasewhencoughing,bendingdown,loweringone’sheads.

ClinicalmanifestationReasons:meninges,bloodvesselsandnervesarepulledupon.26编辑pptClinicalmanifestationFrequentlyseenintumorslocatedinposteriorcranialfossaand4thventricle.

Headacheisatypicalinchildren.

VomitingUsuallyappearswhenheadacheissevere,accompaniedbynausea.Thetypicalisprojectile.27编辑ppt

Papilledema

Isthemostobjectivesign.It’scharacterizedbyopticpapillarycongestion,theindistinctmargins,theexcavationdisappearance,opticdiscprojection,venousengorgementandarterialtwistiness.Clinicalmanifestation28编辑pptpapilledema29编辑ppt6.Diagnosis30编辑ppt

Placeweightoncasehistory,somatoscopy,especiallyNSexamination.Diagnosis(1)LumbarvertebraepunctureAccessoryexamination.31编辑pptAccessoryexamination.

Diagnosis(2)Theplainradiographoftheskull32编辑pptAccessoryexamination.

Diagnosis(3)CerebralVascularAngiographydigitalsubtractionAngiography,DSA3D-DSA33编辑pptAccessoryexamination.

Diagnosis(4)CT&MRI34编辑pptTreatment7.Treatments35编辑ppt7.1.GeneraltreatmentObserveT,P,R,Bp,consciousness,pupilPreventinhalationpneumoniaPayattentiontofluidinfusion,acid-basebalancePayattentiontolooseningthebowelsKeepairwayunobstructedOxygeninhalationTreatment7.Treatment36编辑ppt7.2.Etiologicaltreatment

Space-occupyingfocus:removalHydrocephalus:by-passoperationofCSF

eg.VentriculoperitonealshuntAcutebrainhernia:emergencysurgeryTreatment37编辑ppt7.2.Etiologicaltreatment:OperativetreatmentTreatment38编辑pptSphenoidalmeningioma

EtiologicaltreatmentTreatmentSpace-occupyingfocus:removal39编辑pptIntraoperationTreatmentEtiologicaltreatment40编辑pptSphenoidalmeningiomaTreatmentEtiologicaltreatment2'38"41编辑pptTreatmentEtiologicaltreatmentHydrocephalus:by-passoperationofCSFeg.Ventriculoperitonealshunt42编辑ppt43编辑ppt44编辑ppt45编辑pptEtiologicaltreatmentTreatmentAcutebrainhernia:emergencysurgery.eg.Epiduralhematoma46编辑pptEpiduralhematoma47编辑pptThoroughlystopbleeding48编辑ppt49编辑pptSubduralexploration50编辑ppt7.3.VentriculocentesisVeryeffectiveemergencymeasurestosevereincreasedICP!Treatment(Schematicdiagram)51编辑pptTreatmentPuncturetransanteriorhornoflateralventricleVentriculocentesis52编辑pptTreatment

7.4.DehydrationtherapyMannitol20%Glucosi50%Furosemide(Lasix)

Glycerinfructose

HydrochlorothiazideDimox53编辑pptTreatment

7.5.Hormonotherapy

ImprovefunctionofBloodbrainBarrier,BBB，

lowerpermeabilityofcapillary

Desamethasone

Methylprednisolone

Hydrocortisone

Prednisone54编辑ppt7.6.SubhypothermiatherapyLowercerebralmetabolism,ReducecerebraloxygenconsumptionPreventdevelopmentofhydrocephalusTreatment55编辑pptBarbitaltherapy

Overventilation

Antibiotictherapy

Expectanttreatment7.7.Othertreatments56编辑ppt8.HerniationofBrain57编辑ppt8.1.BasicAnatomyAnatomySchematicdiagramofcranialcavity58编辑ppt8.2.CauseofformationICPcausedby

differentreasonsEtiologybraintissuepassdownthepositionwherepressureislowgiverisetoaseriesofclinicsyndromesnamelybrainhernia59编辑pptCommondiseasesleadingbrainherniaEtiologyIntracranialHematomasTumorsIntracranialAbscessIntracranialParasitosisChronicGranulomas

60编辑ppt8.3.PathogenesisPathogenesisThemostimportanceiscausingthesecondarylesionofbrainstem!CirculationofCSFmeetwithobstructionHastenICP

Viciouscircle

61编辑ppt8.4

ClinicalmanifestationTranstentorialherniation(Temporaloncusherniation)Clinicalmanifestation①symptomsofincreasedICP:severeheadache,frequentvomitingwhichaggravatedthanpre-hernia,dysphoria②consciousnesschanges:lethargysuperficialcoma

coma62编辑pptClinicalmanifestationClinicalmanifestationTranstentorialherniation(Temporaloncusherniation)③pupillarychanges:anisocoria——oculomotornerveispulled.accompaniedby

droopingeyelid,exotropiaplatycoria——Oculomotornucleusiscompressed.63编辑pptClinicalmanifestationClinicalmanifestationTranstentorialherniation(Temporaloncusherniation)④dyskinesia

hemiplegia；decerebraterigidity——brainstemisdamagedseverely！⑤vitalsignsdisordered

T、P、R、Bp64编辑pptTransforamenmagnaherniation(Tonsillarherniation)ClinicalmanifestationClinicalmanifestationHerniadownwardCerebellartonsiliscompressedIncreasedICPbelowtentorium

Space-occupyinglesionsinposteriorfossa65编辑pptSevereheadache,repeatedvomiting,disorderedvitalsigns,suddenstoppedrespiration,withoutpupillarychanges.ClinicalmanifestationClinicalmanifestationTransforamenmagnaherniation(Tonsillarherniation)66编辑pptTreatment8.5.Treatment

DehydrationtherapyVentriculocentesisDecompressionoperationV-PshuntInternaldecompressionoperationOthers67编辑pptSummary

ICP>2kPa:IncreasedICPHeadache,VomitingandPapilledemaarethethreemajorsignandsymptomsHerniationistheseverestConsequences

68编辑ppt

OperativetreatmentsVentriculocentesisNon-operativetreatmentsSummary69编辑pptMultiplechoicequest