Journal of Surgery Current Trends & Innovations Category: Clinical Type: Review Article
Intractable Intracranial Hypertension: A Literature Review
- Dennis Adjepong, MD, MBA1*
- 1 Department Of Neurological Surgery, California Institute Of Behavioral Neurosciences & Psychology, Fairfield, United States
*Corresponding Author:Dennis Adjepong, MD, MBA
Department Of Neurological Surgery, California Institute Of Behavioral Neurosciences & Psychology, Fairfield, United States
Received Date: Apr 03, 2020 Accepted Date: Apr 10, 2020 Published Date: Apr 17, 2020
Effective controlling of the Intractable Intracranial Hypertension (IIH) usually comprises careful dodging of features that in most cases do precipitate or increase the intracranial pressure. In a situation where intracranial pressures become elevated, it is imported ruling out innovative physique lesions that should surgically be expatriated. Very often medicinal organization of the augmented intractable intracranial hypertension or pressures should involve the aspect of sedation, drainage or the cerebrospinal fluid and in other instances osmotherapy with either mannitol or in other instances hypertonic salty. For intracranial hypertension headstrong to an initial medicinal organization, barbiturate coma or the decompressive craniotomy ought to often be put into consideration. However, the use of the Steroids is not normally designated and might however be very damaging in the action of the intractable intracranial hypertension that results from the traumatic wound of the brain.
Barbiturate coma; Craniotomy; Intractable hypertension; Intractable intracranial hypertension; Sedaton; Traumatic brain injury
Intractable Intracranial Hypertension (IIH) is a mutual difficulty of neurologic in judgmentally sick people [1-4]. It’s the common way in the performance of the various neurologic and non-neurologic illnesses . The original pathophysiology of the amplified intractable intracranial hypertension is often the subject of the interest basic and clinical studies, which takes or resulted in advances in the overall empathetic of the makeup associated with the diseases. The disorder is linked to the worse outcomes after an acute injury of the brain and experimental strategies do promote for initial organization of the disease . The intractable intracranial hypertension sinking treatments are often ordered in a stepwise way, beginning with safer first-line interventions, while keeping advanced dangers choices for patients with intractable intracranial hypertension .
The methodology of the study involves the analysis of the other sources which have been written on intractable intracranial hypertension diseases . It consists of the review of secondary sources on the information concerning the intractable intracranial hypertension . The data from the different articles and healthcare journals will be coordinated to develop a proper understanding of these diseases, including the signs and symptoms, the clinical implication, pathophysiology, biochemistry, genetics, and the scientific analysis of diseases. However, the gap which exists in the study will be identified .
The various cause of intractable intracranial hypertension can happen individually or in numerous combinations. The main cause of the increased intractable intracranial hypertension, however, depends on a rapidly addressing the underlying disorder of the brain. The primary cause of IIH normalization is a result of the extra cranial or sympatric procedure that normally results in remediable . The last group is however made up of increased cases of the IIH after a neuroglial process. Some of the primary causes of the IIH though not limited to such include brain tumor, trauma, nondramatic intra cerebral hemorrhage, ischemic stroke, and the hydrocephalus. The extra cranial of the secondary cause of the intractable intracranial hypertension includes; the obstruction of airways, posture, seizure, drug and metabolic and hypertension .
Pathophysiology of intractable intracranial hypertension
After an atraumatic injury in the grain area, a decompressive craniotomy associated with relatively declined mortality that is associated with medical managing but difficult tariffs of nonsexual states or in other cases stark incapacity . In patients with the stroked connected malicious function of the hemispheric infarction, Hemi-craniotomy greatly reduced the rate of humanity and improves the fictional consequence in grownups below the age of 60 . It has also been established that surgery does reduce the mortally of those above the age of 60 years suffering from intractable intracranial hypertension. For those suffering from the disorder, the decision for the recommendation of the decompressive craniotomy must often be completed not only in the situation of its scientific indicators but also after deliberation of a personality’spatient’spartialities and the life excellence prospects .
Biochemistry of intractable intracranial hypertension
The latest from brain trauma foundation does recommend intractable intracranial hypertension lowering therapy after traumatic brain injury when intractable intracranial hypertension goes above 22mmHg . Modern neocritical care management does incorporate tired IIH and the Cerebral Perfusion Pressure guided strategies that do include both medical and surgical interventions to help reduce the chances of reoccurrence of this condition . The disorder lowering therapies are normally administered in a procedural way that starts with first-line interventions while at the same time reserving the greater risk option for most patients with intractable intracranial hypertension . The actual equipment for escalation of treatment for intractable intracranial hypertension do imply a more severe disease and is normally linked with poorer prognosis; the relevant risk of death is in this way increased by over 60% in patients whom escalation to stage 2 IIH lowering kind of interventions is very necessary .
Genetic basis of intractable intracranial hypertension
There is no evidence linking the disease to any genetics. Since the diseases as a result of various external factors, little evidence links it to any genetic history. The prevention or the treatment factor of the IPP may be aggravated or precipitate intracranial hypertension is the core of neurological care. Some specific factors that might act by aggravating the latest from brain trauma foundation do recommend IIH lowering therapy after Traumatic Brain Injury when IIH goes above 22mmHg. Modern neocritical care management does incorporate tired IIH and the Cerebral Perfusion Pressure guided strategies that do include both medical and surgical interventions to help reduce the chances of reoccurrence of this condition . The disorder lowering therapies are normally administered in a procedural way that starts with first-line interventions while at the same time reserving the greater risk option for most patients with intractable intracranial hypertension .
Scientific analysis of intractable intracranial hypertension
The actual equipment for escalation of treatment for intractable intracranial hypertension does imply a more severe disease and is normally linked with poor prognosis; the relevant risk of death is in this way increased by over 60% in patient whom escalation to stage 2 IIH lowering kind of interventions is very necessary . Do include obstruction of venous, repository problems and fevers which can be deal with depending on the actual cause of the problem. The management of patients with acute injury of the brain is the central concept behind the prevention of the secondary injuries of the brain which are often the cause of the intractable intracranial hypertension .
The two articles which were used in the development of the report with the help of others included Chassard et al. and Sadraei et al. . The two articles were important in the development of this report since both had information relating to intractable intracranial hypertension. However, I do prefer, Saraie et al. over that of Chassed et al. because it is more elaborate detailed and is well organized. As a result of this, extracting information from it is quite simple .
The clinical implication of intractable intracranial hypertension
Indications of intractable intracranial hypertension bear a resemblance to those of brain tumors notwithstanding no lump life contemporary. Signs of intractable intracranial hypertension may contain austere headache, nausea and vomiting, altered vision, and vivacious noises in the head . An individual with intractable intracranial hypertension might also have signs such as a firm neck, back or arm agony, eye pain, and memory difficulties. If the illness is not treated, enduring visual loss or loss of sight might ensue .
Unanswered questions of intractable intracranial hypertension
The only mystery which remains unsolved in the study or understanding of intractable intracranial hypertension is on the element of clinical makeup which is associated with this condition. In most cases, the clinical implication of intractable intracranial hypertension is never cleared and nonconventional. This makes it difficult for the actual understanding of the real cause to be arrived at.
CONCLUSION AND FUTURE PERSPECTIVES
Intractable intracranial hypertension is a brain disorder that is normally associated with head injury both primary and secondary . For the treatment of the disease, and early intervention is recommended for those who have shown the symptoms of the disease . Intractable intracranial hypertension can result in death or some form of devastating neurological damage either through reduction of the perfusion pressure that occurs in the brain and most cases result in cerebral ischemia or by the compression and causing herniation of the brainstem or other related vital structure . There is a need for anyone suspected of the symptom of the disease to move quickly and get the recommended intervention for the disorder before it gets to an irreversible state .
- Baomin L, Yongbing S, Xiangyu C (2014) Angioplasty and stenting for intractable pulsatile tinnitus caused by dural venous sinus stenosis: A case series report. Europe PMC 35: 366-370.
- Burchiel KJ (2012) Idiopathic intracranial hypertension and sinus stenting. J Neurosurg 116: 536-537.
- Colton K, Yang S, Hu P, Chen H, Scalea T, et al. (2014) 1061: Hemodynamic changes after decompressive craniectomy for intracranial hypertension. Critical Care Medicine 42: 1615.
- Desgranges FP, Javouhey E, Mottolese C, Migeon A, Szathmari A, et al. (2014) Intraoperative blood loss during decompressive craniectomy for intractable intracranial hypertension after severe traumatic brain injury in children. Childs Nerv Syst 30: 1393-1398.
- Ellis JA, Anderson RC, O'Hanlon J, Goodman RR, Feldstein NA, et al. (2012) Internal cranial expansion surgery for the treatment of refractory idiopathic intracranial hypertension. Journal of Neurosurgery 10: 14-20.
- Fields JD, Javedani PP, Falardeau J, Nesbit GM, Dogan A, et al. (2013) Dural venous sinus angioplasty and stenting for the treatment of idiopathic intracranial hypertension. J Neurointerv Surg 5: 62-68.
- Fink ME (2012) Osmotherapy for intracranial hypertension: mannitol versus hypertonic saline. Continuum 18: 640-654.
- Glimåker M, Johansson B, Halldorsdottir H, Wanecek M, Elmi-Terander A, et al. (2014) Neuro-intensive treatment targeting intracranial hypertension improves outcome in severe bacterial meningitis: An intervention-control study. PloS one 9: 91976.
- Hoffman KR, Chan SW, Hughes AR, Halcrow SJ (2015) Management of cerebellar tonsillar herniation following lumbar puncture in idiopathic intracranial hypertension. Case reports in Critical care 2015.
- Helena DN, Tolstoy NS, Mills AM, Fox AD, Levine JM (2012) Therapeutic hypothermia for treatment of intractable intracranial hypertension after liver transplantation. Am J Crit Care 21: 72-75.
- Holsgrove DT, Kitchen WJ, Dulhanty L, Holland JP, Patel HC (2014) Intracranial hypertension in subarachnoid hamorrhage: Outcome after decompressive craniectomy. Acta Neurochir Suppl 119: 53-55.
- Honeybul S, Ho KM (2012) Incidence and risk factors for post-traumatic hydrocephalus following decompressive craniectomy for intractable intracranial hypertension and evacuation of mass lesions. Europe PMC 29: 1872-1878.
- Honeybul S, Ho KM (2012) The surgical management of intracranial hypertension following traumatic brain injury. Anaesth Intensive Care 40: 558-559.
- Jahromi AH, Freeland K, Youssef AM (2012) Intra-abdominal hypertension causes disruption of the blood-brain barrier in mice, which is increased with added severe head trauma. J Trauma Acute Care Surg 73: 1175-1179.
- Khalili H, Sadraei N, Niakan A, Ghaffarpasand F, Sadraei A (2016) Role of Intracranial Pressure Monitoring in Management of Patients with Severe Traumatic Brain Injury: Results of a Large Level I Trauma Center in Southern Iran. World neurosurg 94: 120-125.
- Kim JM, Kwok SK, Ju JH, Kim HY, Park SH (2012) Idiopathic intracranial hypertension as a significant cause of intractable headache in patients with systemic lupus erythematosus: A 15-year experience. Lupus 21: 542-547.
- Kumpe DA, Bennett JL, Seinfeld J, Pelak VS, Chawla A, et al. (2012) Dural sinus stent placement for idiopathic intracranial hypertension. J Neurosurg 116: 538-548.
- Lai LT, Danesh-Meyer HV, Kaye AH (2014) Visual outcomes and headache following interventions for idiopathic intracranial hypertension. J Clin Neurosci 21: 1670-1678.
- Le Roux P (2016) Intracranial pressure monitoring and management. In Laskowitz D, Grant G (eds.). Translational Research in Traumatic Brain Injury. CRC Press/Taylor and Francis Group Boca Raton, USA.
- Mak CH, Lu YY, Wong GK (2013) Review and recommendations on management of refractory raised intracranial pressure in aneurysmal subarachnoid hemorrhage. Vasc Health Risk Manag 9: 353-359.
- Puffer RC, Mustafa W, Lanzino G (2013) Venous sinus stenting for idiopathic intracranial hypertension: A review of the literature. Journal of neurointerventional surgery 5: 483-486.
- Smith M (2017) Refractory intracranial hypertension: The role of decompressive craniectomy. Anesth Analg 125: 1999-2008.
- Spitze A, Malik A, Lee AG (2014) Surgical and endovascular interventions in idiopathic intracranial hypertension. Curr Opin Neurol 27: 69-74.
- Stein DM, Brenner M, Hu PF, Yang S, Hall EC, et al. (2013) Timing of intracranial hypertension following severe traumatic brain injury. Neurocrit Care 18: 332-340.
- Youssef AM, Jahromi AH, Vijay CG, Granger DN, Alexander JS (2012) Intra-abdominal hypertension causes reversible blood-brain barrier disruption. J Trauma Acute Care Surg 72: 183-188.
- Zur D, Naftaliev E, Kesler A (2015) Evidence of multidomain mild cognitive impairment in idiopathic intracranial hypertension. J Neuroophthalmol 35: 26-30.
- Almarzouqi SJ, Morgan ML, Lee AG (2015) Idiopathic intracranial hypertension in the Middle East: A growing concern. Saudi J Ophthalmol 29: 26-31.
Manfield JH, Yu KK, Efthimiou E, Darzi A, Athanasiou T, et al. (2017) Bariatric surgery or non-surgical weight loss for idiopathic intracranial hypertension? A systematic review and comparison of meta-analyses. Obes Surg 27: 513-521.
Citation:Adjepong D (2020) Intractable Intracranial Hypertension: A Literature Review. J Surg Curr Trend Innov 4: 031
Copyright: © 2020 Dennis Adjepong, MD, MBA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.