颅内高血压英文 ppt课件

,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Intracranial Pressure Physiology,Monro-Kellie Doctrine(1783/1824),1.Rigid container,2.Liquid contents are incompressible,3.Mass must be displaced,Intracranial Pressure Physiology,Cranial Contents,Total Volume 1300-1500 cc,Brain 80%gray matter/white matter,CSF 10%,Intraventricular 50%75 cc,Subarachnoid 50%75 cc,Blood 10%,Arterial 30%45cc,Venous 70%105cc,Intracranial Pressure Pathophysiology,Blood epidural,subdural,subarachnoid,intracerebral,intraventricular,intravascular,Tumor,Abscess/Infection,Foreign Objects,Air pneumocephalus,Cranial RestrictionPagets disease,craniosynostosis,Hydrocephalus,Cysts,Hygroma,Edema,Interstitial e.g.CNS lymph system,brain as a sponge,Cytotoxic dead/dying cells,Vasogenic altered BBB,capillary breakdown,abscess,Intracranial Pressure Pathophysiology,Mass Displacement,CSF,Blood,Brain,ICP/CPP,150,125,100,75,50,25,0,0,25,50,Cerebral Perfusion Pressure(mm Hg),Cerebral Blood Flow,(ml/100 g/min),Zone of Normal,Autoregulation,Maximum,Constriction,Maximum,Dilatation,Passive,Collapse,0,25,50,ICP(mm Hg),Vasodilatory Cascade Zone,Autoregulation Breakthrough Zone,Stephan A.Mayer,MD,Intracranial Pressure Physiology,Intracranial Pressure Pathophysiology,Herniation TypesStructureBarrierVessel,Subfalcine cingulate g.falxACA,Uncal uncustentoriumPCA,Tonsillarcerebellumforamen m.vert/b,Upwardcerebellumtentorium,Transcalvarialcortexskullsurface,Intracranial Pressure Pathophysiology,Herniation Types,Subfalcine,Uncal,tonsillar,Intracranial Pressure Pathophysiology,Elevated ICP Clinical Symptoms,Headache-Aggravated by bending and stooping.Caused by distortion or irritation of pain sensitive areas in the dural coverings and blood vessels.,Vomiting-Caused by compression or ischemia of brainstem.Usually occurs with lesions of the posterior fossa.This is usually the result of hydrocephalus and 4,th,ventricle dilation causing stimulation of the nucleus of vagus nerve.,Personality and behavior changes-A depression in motor and thought processes that can lead to somnolence,and decreased level of consciousness and coma.Caused by compression on the,reticular substance,of upper brainstem and thalamus causes this phenomenon.,Papilledema-this is usually the result of increased CSF pressure in the optic nerve sheath impeding venous drainage and axoplasmic flow in optic neurons.,Papilledema,Death 12 months,Papilledema,Elevated ICP Clinical Symptoms,Intracranial Pressure Pathophysiology,Cerebral Perfusion Pressure(mm Hg),Severe disability or death 12 months,Intracranial Pressure Physiology,BUT MY BRAINS KEPT FALLING OUT George Carlin,Hemicraniectomy,Caused by compression on the reticular substance of upper brainstem and thalamus causes this phenomenon.,Mass Displacement,Elevated ICP Clinical Symptoms,Subarachnoid 50%75 cc,Total Volume 1300-1500 cc,CSF 10%,Autoregulation,This is usually the result of hydrocephalus and 4th ventricle dilation causing stimulation of the nucleus of vagus nerve.,Interstitial e.,Hypertonic Saline,(ml/100 g/min),Elevated ICP Clinical Symptoms,Cranial Neuropathy,CN III or VI,Cushings Triad,Hypertension/Increased Pulse Pressure,Bradycardia,Irregular Respiration,Elevated ICP Clinical Symptoms,ICP Measurement,Radiographic,Not particularly accurate,Other Non-invasive,Unproven:infra-red,laser,TCD(Pulsatility Index),Invasive,Lumbar puncture,Other,ICP Measurement,ICP Treatment,Head of Bed 30 degrees,Improves venous drainage,Lasix,Diuretic decreases intravascular volume,Mannitol (older agents glycerol,urea),Osmotic diuretic,Diuretic decreases intravascular volume,Osmotic agent removes free water by osmosis,Viscosity improves micro-circulation,ICP Treatment,Sedation/Agitation,Decrease unnecessarily elevated blood pressure and intravascular volume,Intubation/Hyperventilation,Decrease pCO2(25-30 torr),change H+gradient at blood vessel causing vasoconstriction,leading to decreased intravascular volume,Fever control,Hyperthermia leads to increased cerebral blood flow and increased blood volume,ICP Treatment,Barbiturate Coma,Decrease cerebral metabolic demand,Hypothermia,Decrease cerebral metabolic demand,Hypertonic Saline,Osmotic gradients,Surgery,Elevated ICP Treatment,Elevated ICP Treatment,I USED TO HAVE AN OPEN MIND,BUT MY BRAINS KEPT FALLING OUT,George Carlin,Hemicraniectomy Trials,DECIMAL-France,DESTINY-Germany,HAMLET-Netherlands,Combined Analysis,NIHSS 15,MCA stroke,Within 45 hours,Intracranial Pressure Pathophysiology,Foreign Objects,Papilledema,Hypertension/Increased Pulse Pressure,Elevated ICP Clinical Symptoms,Interstitial e.,This is usually the result of hydrocephalus and 4th ventricle dilation causing stimulation of the nucleus of vagus nerve.,Air pneumocephalus,Elevated ICP Treatment,Elevated ICP Clinical Symptoms,Mass must be displaced,Liquid contents are incompressible,Viscosity improves micro-circulation,Head of Bed 30 degrees,Mass Displacement,DECIMAL-France,Intracranial Pre