Three elements are located in the intracranial space.
• 80% brain parenchyma,
• 10% of CSF,
• Blood elements make up 10%.
Brain + V CSF + V Blood + V Mass = Fixed
The change in any of these 3 elements or the addition of foreign masses to the intracranial space is compensated by the escape of CSF or blood elements outside the intracranial distance, which is called the Monro Kellie-Burrows doctrine.
Etiology
• Increased brain volume (edema and space-occupying lesion)
• Increased brain blood volume (HT, sinus thrombosis)
• Increase in CSF volume
• Pseudotumor cerebri
• Craniosynocytosis
Clinic
Main findings
1. Headache:
It is the most common symptom in KIBAS.
2. Vomiting:
It is common in the morning.
3. Papillary Stasis:
The optic nerve is covered by the arachnoid membrane until the area where it enters the eyeball.
Therefore, the increase in intracranial pressure is reflected directly on the optic nerve.
If left untreated, blindness occurs as a result of secondary optic atrophy.
4. Change of consciousness:
It appears recently.
Helpful findings:
1- Diplopia
The 3rd, 4th and 6th nerves are formed as a result of compression or stretching of the cranial nerves.
Particular attention should be paid to the finding of the 6th cranial nerve.
2. Cardiovascular:
Elevated blood pressure, bradycardia, slowed breathing.
This triad is called the Cushing triad.
"The increase in intracranial pressure is seen when it becomes very pronounced.
3. Gastrointestinal
Bleeding from gastric ulcers (Cushing's ulcer)
4. Pulmonary
hemorrhagic pulmonary edema
S. Neurological
In intracranial pressure increase syndrome, clinical findings occur due to ischemia.
The radiological finding of CIBAS is erosion in the sella, the finding in the child is enlargement of the sutures.
The cause of death in KÄ°BAS is herniation.
Treatment of Increased Intracranial Pressure Syndrome
The most effective treatment is to eliminate the etiology.
Blood pressure should be kept normal, normal arterial oxygenation and normothermia should be ensured.
The patient's head should be kept slightly elevated (Semi-Fowler position)
Normoventilation should be provided.
Hypothermia reduces cerebral metabolism, reduces intracranial pressure.
Hyperthermia increases intracranial pressure.
Mannitol infusion: can be used for up to 24-48 hours; but it has been reported to cause fatal elevations in blood pressure, causing acute tubular necrosis.
Steroids (dexamethasone)
Sedation: In patients with high intracranial pressure, sudden, excessive and compelling movements should be avoided as they will cause the pressure to rise even more.