Intracranial hypertension treatment

Suarez JI, Qureshi AI, Bhardwaj A, Williams MA, Schnitzer MS, Mirski M, Hanley DF, Ulatowski JA. Treatment of refractory intracranial hypertension with 23.4% saline. Crit Care Med 1998 26(6) 1118-1122. 

Qureshi A, Suarez JI. Use of hypertonic saline solutions in treatment of cerebral edema and intracranial hypertension. Crit Care Med 2000 28(9) 3301-3313. 

Long-term glucocorticoid treatment can result in papilledema and increased intracranial pressure (the syndrome of pseudotumor cerebri or so-called benign intracranial hypertension ), particularly in children. 

A 6-year-old girl, who had taken prednisone for 2.5 years for nephrotic syndrome with seven relapses in 3 years, developed symptoms of benign intracranial hypertension after oral glucocorticoid dosage reduction over 10 months from 30 mg/day to 2.5 mg/every other day (46). Laboratory studies and head CT scan were normal, but there was bilateral papilledema and the cerebrospinal fluid pressure was increased. She was given prednisone 1 mg/kg/day initially, with acetazola-mide, and 25 ml of cerebrospinal fluid was removed. All her symptoms resolved and treatment was gradually withdrawn. She developed no further visual failure. 

Headache is a common adverse effect of somatropin. It often occurs early in treatment and usually responds to temporary dosage reduction followed by gradual re-esca-lation (1,24). It can be an early indicator of the rare complication pseudotumor cerebri (idiopathic intracranial hypertension), particularly in high-risk groups, such... 

Bala P, McKiernan J, Gardiner C, O Connor G, Murray A. Turner s syndrome and benign intracranial hypertension with or without growth hormone treatment. J Ped Endocrinol Metab 2004 17 1243 1. 

Excessive use of vitamin A can result in ocular dryness, loss of lashes, night blindness, and even intracranial hypertension, the latter of which is similar to that occurring with the other forms of vitamin A such as isotretinoin, approved for the treatment of cystic acne. With large doses, increased intracranial pressure is considered certain. ... 

Forbes, A., Alexander, G.J., O Grady, J.G., Keays, R., Gidlan, R., Daw-ling, S., Williams, R. Thiopental infusion in the treatment of intracranial hypertension complicating fulminant hepatic failure. Hepatology 1989 10 306-310... 

Very rarely, in cases of neurocysticercosis, the reaction of the nervous system to the death of the parasite is extremely violent. In one case cerebral edema resulted in permanent neurological damage (22), while other patients have suffered hydrocephalus or acute intracranial hypertension requiring treatment, for example with glucocorticoids or mannitol (23). 

Benign intracranial hypertension (pseudotumor cerebri) mainly affects babies, especially during the first 3 months of life. Occasionally even older children can be affected, especially when inordinately high doses are used (5). Very rarely, it occurs in adults with renal insufficiency. In infancy, impaired nalidixic acid elimination (due to underdeveloped glucuronidation), overdosage, or prolonged treatment may be responsible. Metabolic acidosis is usually important in adults (6). 

Nonspecific pharmacologic treatment in the management of intracranial hypertension should include analgesics, sedatives, antipyretics, and paralytics under selected circumstances. 

Specific pharmacologic treatment in the management of intracranial hypertension includes mannitol, furosemide, and high-dose pentobarbital. Neither routine use of corticosteroids nor aggressive hyperventilation (i.e., Paco2 <25 mm Hg) should be used in the management of intracranial hypertension. 

Adverse effects of tetracyclines include resistant bacteria, folliculitis, candidiasis, gastrointestinal upset, and phototoxic effects. Tetracyclines must not be combined with systemic retinoids because of the increased probability for development of intracranial hypertension. Tetracycline is used in the treatment of moderate to severe acne vulgaris. It is the least expensive of the tetracyclines and therefore often prescribed for initial therapy. A common initial approach includes tetracycline 1 g daily (500 mg twice daily), 1 hour before meals after 1 or 2 months, when marked improvement of inflammatory lesions is observed, the dose may be decreased to 500 mg every day, for another 1 or 2 months. Drawbacks to the use of tetracycline include also a drug-food interaction with dairy prodncts. 

Hypothermia extends the survival time and prevents the development of brain edema in rats with ALE, caused by hepatic devascularization and mild hypothermia (33—35°C), reduces ammonia-induced brain swelling and increased intracranial pressure in portacaval-shunted rats administered ammonium salts. These findings have led to the successful use of mild hypothennia for the treatment of uncontrolled intracranial hypertension in patients with ALF (Jalan et al., 1999). Mechanisms so far identified that underhe the beneficial effect of hypothermia in ALF include reduced blood-brain transfer of ammonia, improved cerebrovascular hemodynamics and normafization of extracellular brain amino acid patterns (for review of these mechanisms, see Vaquero et al., 2005). Mild hypothermia also improves hepatic function in experimental toxic fiver injury (Vaquero et al., 2(X)7) Mild-to-moderate hypothermia has the potential to serve as an important strategy in the management of patients with ALF awaiting liver transplantation. 

Cognard C, Casasco A, Toevi M et al (1998) Dural arteriovenous fistulas as a cause of intracranial hypertension due to impairment of cranial venous outflow. J Neurol Neurosurg Psychiatry 65 308-316 Collice M, D Aliherti G, Arena O et al (2000) Surgical treatment of intracranial dural arteriovenous fistulae role of venous drainage. Neurosurgery 47 56-66 discussion 66-57... 

Perez-Barcena J, Llompart-Pou JA, Homar J, Abadal JM, Raurich JM, Frontera G, Brell M, Ibdnez J, Ibtihez J. Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury a randomized controlled trial. Crit Care 2008 12(4) R112. 

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