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Increased Intracranial Pressure Medicine Neurology Physiotherapy

Management of increased intracranial pressure (ICP)

In this article we will discuss the Management of Increased Intracranial Pressure (ICP)

In this article, we will discuss the Management of increased intracranial pressure (ICP). So, let’s get started.

Management

1. Treatment of the underlying cause: The ideal treatment of raised intracranial pressure is to find out the cause and treat it accordingly, for example CSF diversion for hydrocephalus, drainage of an abscess, removal of a clot or a tumor.

2. Measures to reduce intracranial pressure: There are some medical and surgical measures to reduce the ICP, which may prove life-saving. generally and any ICP above 25 mmHg needs treatment.

A. General

  • Intubation and hyperventilation are used to lower the ICP in patients with coma and unilateral pupillary changes (herniation) until definite treatment can be instituted.
  • Airway patency to be insured and maintained. Elevate the head by 30 to 45 degree. Avoid neck flexion.
  • Symptomatic treatment with antibiotic, analgesics and anticonvulsants (if convulsions occurs)
  • Adequate hydration by fluids. avoid hypotonic fluids.
  • Catheterization of bladder to avoid straining.

B. Medical treatment: The drugs that reduce the ICP are given below. Sedation and neuromuscular paralysis, if necessary (patient will require endotracheal intubation and mechanical ventilation).

  1. Mannitol (20%) e.g. 100 ml I.V. 4-6 hourly
  2. Glycerol (10%) e.g. 1-2 g/kg over 4 hours
  3. Dexamethasone: It is used in vasogenic ICP. Dose is 10-20 mg/24 hour in divided doses
  4. Furosemide e.g. 20-40 mg I.V.

C. Surgical

  • Ventricular drainage: Lumbar drainage is indicated as an emergency procedure only in benign raised intracranial hypertension.
  • Long-term measures for reduction of elevated intracranial pressure involve shunting procedures that is ventriculoperitoneal shunt, lumbar peritoneal shunt, endoscopic third ventriculostomy and endoscopic stent placement in cerebral aqueduct.
  • Treatment of refractory raised intracranial pressure: High-dose Barbiturates, hemicraniectomy or hypothermia are sometimes used for refractory cases of raised intracranial pressure.

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