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Management of intracranial hypertension

Leonardo Rangel-Castilla1, Leonardo Rangel-Castillo, Shankar Gopinath

  • 1Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA.

Neurologic Clinics
|June 3, 2008
PubMed

Insights

Effective intracranial hypertension management requires avoiding triggers and addressing new mass lesions. Treatments include CSF drainage, osmotherapy, and potentially barbiturate coma or hypothermia for refractory cases.

Area of Science:

  • Neurosurgery
  • Critical Care Medicine

Background:

  • Intracranial hypertension (ICH) is a critical condition requiring prompt management.
  • Elevated intracranial pressure (ICP) can lead to secondary brain injury.

Purpose of the Study:

  • To outline effective strategies for managing intracranial hypertension.
  • To detail medical and surgical interventions for elevated ICP.

Main Methods:

  • Review of current guidelines and evidence for ICH management.
  • Discussion of medical therapies including sedation, CSF drainage, and osmotherapy.
  • Consideration of advanced therapies for refractory ICH.

Main Results:

  • Avoidance of precipitating factors is crucial.
  • Surgical evacuation of mass lesions is indicated when present.
  • Medical management includes sedation, CSF drainage, and osmotherapy (mannitol or hypertonic saline).
  • Refractory ICH may require barbiturate coma, hypothermia, or decompressive craniectomy.
  • Steroids are contraindicated in traumatic brain injury-related ICH.

Conclusions:

  • A multi-faceted approach is essential for managing intracranial hypertension.
  • Timely intervention with appropriate medical and surgical therapies improves outcomes.
  • Specific treatments should be tailored to the underlying cause and severity of ICH.

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