traumatic low intracranial pressure syndrome
Introduction
Introduction to traumatic low intracranial pressure syndrome Post-traumatic low intracranial pressure syndrome refers to the syndrome of cerebrospinal fluid pressure of the laterally lumbar puncture of the injured patient is less than 7.84 kPa (80 mmH2O), and the syndrome of erectile headache, nausea, vomiting and dizziness caused by low intracranial pressure is the main clinical manifestation. The clinical manifestations are similar to the increase of intracranial pressure. Because of different treatment methods, it is necessary to discriminate carefully. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: subdural hematoma
Cause
Traumatic low intracranial pressure syndrome
(1) Causes of the disease
Post-traumatic low intracranial pressure syndrome is common in the following cases: cerebral vasospasm after injury, shock, severe dehydration, hyponatremia, etc., so that the choroid plexus secretion of cerebrospinal fluid function is inhibited, so that the cerebrospinal fluid is too small; cerebrospinal fluid leakage lumbar puncture release cerebrospinal fluid and The cerebrospinal fluid flows out of the subarachnoid space from the needle hole, which can reduce the amount of cerebrospinal fluid in the ventricular system and the subarachnoid space.
(two) pathogenesis
The range of normal intracranial pressure should be between 7.84 and 11.8 kPa (80-120 mmH2O). The intracranial pressure after general brain injury often increases to varying degrees, and the performance is low intracranial pressure. Less, some patients have had increased intracranial pressure in the early stage after injury, and intracranial hypotension occurred after sputum.
The pathogenesis of post-traumatic low intracranial pressure syndrome has not been elucidated. The reduction of cerebrospinal fluid production or excessive absorption and outflow may be closely related to the occurrence of post-traumatic low intracranial pressure syndrome. The cause of headache may be related to intracranial blood vessels. It is related to the pressure; it is related to the change of the content of the skull and the change of the tension of the meninges; or the compensatory regulation of the volume of the cranial cavity, which makes the blood volume and the amount of cerebrospinal fluid complementary, which is caused by intracranial vasodilation.
Prevention
Traumatic low intracranial pressure syndrome prevention
If there is cerebrospinal fluid leakage, it should be treated promptly, and patients with hyponatremia and dehydration should timely supplement blood volume and sodium salt.
Complication
Traumatic low intracranial pressure syndrome complications Complications subdural hematoma
Individual patients may have a subdural hematoma.
Symptom
Traumatic low intracranial pressure syndrome symptoms common symptoms nausea conscious disorder dizziness low intracranial pressure syndrome paralysis blood pressure low pulse fine speed anorexia dehydration vertigo
Headache
It is characterized by headache reduction or disappearance when the supine head is low, and it is aggravated when standing upright. It occurs 1 to 2 hours after head trauma, and is common in the forehead and posterior occiput. In severe cases, it can spread throughout the head and to the neck, back, shoulder and lower limbs. The headache is most prominent after 2 to 3 days after the injury.
2. nausea, vomiting, dizziness
Often occurs in the head position, after a severe headache, dizziness, nausea and vomiting can occur, and in severe cases, disturbance of consciousness can occur.
3. Autonomic dysfunction
There may be pulse speed, low blood pressure, photophobia, fatigue, anorexia, dehydration and neck stiffness, facial and neck skin may have paroxysmal flushing, anorexia, fatigue and other performance.
4. Neurological examination
There are no positive signs. In some cases, the brain tissue loses the cushioning and cushioning effect of cerebrospinal fluid, so that the cranial nerves are directly squeezed or involved, and the pupils may be different and the nerves are paralyzed. Pay attention to the differentiation of intracranial pressure. .
Examine
Examination of traumatic low intracranial pressure syndrome
Lumbar puncture: lumbar puncture intracranial pressure <7.84kPa, protein content is normal or slightly increased, negative quinine test can exclude subarachnoid obstruction, intrathecal injection of physiological saline to relieve symptoms when the intracranial pressure is elevated.
Diagnosis
Diagnosis and diagnosis of traumatic low intracranial pressure syndrome
The diagnosis of traumatic low intracranial pressure syndrome relies mainly on clinical features and lumbar puncture pressure to confirm the diagnosis. Clinically, after a head injury, heavier symptoms such as dizziness, headache, fatigue, anorexia, etc., are inconsistent with the severity of brain damage, especially when there is a significant increase in head-head headache and a reduction in head pain. That is, the possibility of intracranial hypotension should be considered. If the lumbar puncture position is below 80mmH2O, the diagnosis can be confirmed. If the pressure is lower than 40mmH2O, it is a severe low intracranial pressure, often accompanied by severe water loss and electrolyte imbalance. As the intracranial pressure is significantly reduced, the brain volume is reduced, the intracranial vein is dilated and pulled, which is prone to oozing or bleeding. Therefore, the cerebrospinal fluid is often yellow or has a different number of red blood cells, and the protein content is slightly higher. Therefore, some authors have suggested that lumbar puncture should not be performed for patients with intracranial hypotension, so as to avoid further aggravation of cerebrospinal fluid loss. It is recommended to use the ventricle drilling method to understand the intracranial hypotension, which is accurate and safe. In fact, in the brain imaging examination has been highly developed today, as long as the clinical characteristics are consistent, if the CT or MRI examination has excluded other potentially confusing lesions, it can be confirmed by treatment trials, with supine or high head, inhalation A mixture of 52 and 95% O2 is used for 5 to 10 minutes or 10 to 15 ml of distilled water is intravenously injected to observe whether the headache is relieved or disappeared.
