Intracranial hypertension in acute liver failure

Authors: Donald Richardson 1 and Mark Bellamy 2 

1Department of Nephrology, York District Hospital, York and
2Department of Anaesthesia, St James University Hospital, Leeds, UK

The development of liver failure is a medical emergency requiring specialist assessment and care. The development of renal failure in the patient with hepatic failure is one of the few prognostic indicators of poor outcome. Its presence is associated with prolonged intensive care unit (ICU) stay, prolonged hospitalization and death . The high incidence of renal failure with necessity for dialysis support requires the nephrologist to have an understanding of liver failure and its concomitant complications. Indeed the nephrologist may be called upon outside of a liver centre to provide advice and may be in a position to guide subsequent management and referral to an appropriate centre or within that centre may be asked to assist with investigation and management. An understanding of the causes and treatments of intracranial hypertension will better arm the nephrologist in the management of this syndrome.

Benign intracranial hypertension and chronic renal failure

Authors: Chang D, Nagamoto G, Smith WE.

Department of Nephrology, Medical College of Virginia, Richmond 23298-0160.

Benign intracranial hypertension (also called pseudotumor cerebri, otitic hydrocephalus, or meningeal hydrops) is a syndrome of markedly elevated intracranial pressure in the absence of intracranial mass, inflammation, or obstruction. Numerous disease processes and medications have been associated with it. However, renal failure has not been documented as an associated condition. In this report, the case of a 27-year-old Native American man with chronic renal failure of unknown etiology is described, with new-onset headache, papilledema, and elevated intracranial pressure. After normal cerebrospinal fluid, computed tomography, and magnetic resonance imaging studies, a diagnosis of benign intracranial hypertension was made. Despite repeated lumbar punctures with cerebrospinal fluid removal, the patient's headaches persisted, and intracranial pressures remained in the 200 to 400 mm H2O range. After initiation of hemodialysis due to progressive deterioration of renal function, the patient's headaches became less severe and eventually disappeared. This case represents a unique association of chronic renal failure with benign intracranial hypertension.

Measurements of eye distortions caused by elevated intracranial pressure

Authors: by D Roberts, S G Kosinski, G A Thomas, J Catrambone, W He

We have measured the optical disc region in the eye of patients with elevated intracranial pressure (ICP). We used a scanning laser ophthalmoscope (SLO), which gives a digital measure of the topology. We formulated two measures of the swelling caused by high ICP (called papilledema): 1) depth of the optic disc, and 2) average mean diameter of the swelling. We show that these quantitative evaluations vary systematically with a physicians qualitative grading of the severity of the papilledema.

Space adaptation syndrome is caused by elevated intracranial pressure

Author: Jennings T.

Department of Ophthalmology, University of Illinois, College of Medicine, Chicago 60612.

Space adaptation syndrome (SAS) incapacitates about 50% of the astronauts with symptoms of headache, malaise, vomiting, vertigo, etc. A hypothesis that SAS is caused by elevated intracranial pressure secondary to the cephalad fluid shift in zero G is proposed. A mechanism of how the cephalad fluid shift could cause elevated intracranial pressure is discussed. Factors known to alleviate and exacerbate SAS are interpreted in light of the elevated intracranial pressure mechanism.

Mild traumatic brain injury: a risk factor for neurodegeneration

Authors: Brandon E Gavett 1,2, Robert A Stern 1,2, Robert C Cantu 2,3,4, Christopher J Nowinski 2,3 and Ann C McKee 1,2,5,6 *.

Recently, it has become clear that head trauma can lead to a progressive neurodegeneration known as chronic traumatic encephalopathy. Although the medical literature also implicates head trauma as a risk factor for Alzheimer's disease, these findings are predominantly based on clinical diagnostic criteria that lack specificity. The dementia that follows head injuries or repetitive mild trauma may be caused by chronic traumatic encephalopathy, alone or in conjunction with other neurodegenerations (for example, Alzheimer's disease). Prospective longitudinal studies of head-injured individuals, with neuropathological verification, will not only improve understanding of head trauma as a risk factor for dementia but will also enhance treatment and prevention of a variety of neurodegenerative diseases.

Intracranial pressure in patients with sepsis

Authors: D. Pfister, B. Schmidt, P. Smielewski, M. Siegemund, S. P. Strebel, S. Rüegg, S. C. U. Marsch, H. Pargger and L. A. Steiner.

Findings Fifty-two measurements were performed in 16 patients. ICP could be determined in 45 measurements in 15 patients. Seven patients had an ICP>15 mmHg and 11 patients had a CPP<60 mmHg on at least 1 day. We found no significant correlation between ICP and fluid administration, but low CPP was significantly correlated with elevated S-100β (r=−0.47, p=0.001).

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