Pathophysiology of the Symptoms of Increased Intracranial Pressure

Discuss about the the pathophysiology of the ICP symptoms. Explores the guidelines of ASAH and MTBI in the treatment of ICP.

Elevated Intracranial Pressure (ICP) refers to the pressure increase in the brain cells (Patterson et al., 2018). The condition occurs as a result of the elevation in the number of fluids in the brain. In most occasions, the levels of cerebrospinal fluid increases. The liquid is responsible for protecting the brain against mechanical damage. ICP also occurs as a result of increased amounts of cerebral blood as a result of brain injury (Koziarz et al., 2017). The condition occurs following an injury or from diseases like epilepsy. When not adequately attended to, the situation can result in brain apoptosis.

In the two separate case studies, Tamara and Leo are suffering from a suspected ICP.  Leo is an adult while Tamara is a child indicating that the condition affects all ages. The two patients suffer from Suspected Subarachnoid hemorrhage which precedes ICP.  The dominant symptom of the disease is a severe headache. This essay focuses on the pathophysiology of the ICP symptoms. The paper also explores the guidelines of ASAH and MTBI in the treatment of ICP. Finally, the article discusses the role of the family in the escalation of care.

Leo and Tamara are admitted to the hospital with suspected Increased Intracranial Pressure (ICP).  There signs and symptoms point towards the ICP complication. Both of the two patients are experiencing a severe headache. Tamara vomits, and the physicians observe an increase in urine output in Leo. The 38-year-old patient suffers from a suspected hemorrhage of the subarachnoid. Both patients experience difficulties in opening their eyes.

Elevated ICP leads to visual obstruction, vomiting, and headache (Hayreh, 2016). The two patients jointly experience the first three symptoms. A severe problem occurs as a result of the loose in the coordination of the brain vessels (Hayreh, 2016). The interference of the dorsal tegument at the segment of the medulla causes vomiting (Hayreh, 2016). The difficulties in sight occur as a result of the ischemic attack (Hayreh, 2016). The ischemic condition is due to the anomalies in fluid circulation in the posterior segment of the brain (Hayreh, 2016).

An accident like the one that Tamara experienced leads to the swelling of the brain. The tension in the central nervous system can lead to bursting of blood vessels. The busting explains the suspected subarachnoid hemorrhage that Leo experiences. The brain coordinates all body functions that include vision and urination. Therefore, a complication in the Central Nervous System interferes with vision and results into increased amounts of urine (Wilson, 2016). The occurrence of tumors of the brain and edema deforms the brain cells.

The Guidelines of ASAH and MTBI in the Management of ICP

Epidural hematoma and severe and severe contusions also increase the levels of ICP (Wilson, 2016). The swelling of the brain not only results from accidents but also from failures of the liver and hyperacid complications. The other causes of the tumors explain why Leo had not suffered an accident yet had a subarachnoid hemorrhage. The increased blood pressure elevates the intracranial pressure. Heart attack and thrombosis lead to the increase in blood flow inside the veins (Wilson, 2016). The blocked flow of CNS elevates the brain pressure and can be due to meningitis (Wilson, 2016).

Leo experiences a suspected subarachnoid hemorrhage which is a form of bleeding in the brain cells. The space called subarachnoid exists between the skull and the CNS (Fugate, & Rabinstein, 2015). Cerebral fluid occupies the subarachnoid space. An aneurysm and the malfunctioning of the cerebral vessels lead to the bleeding Fugate, and Rabinstein, 2015). An individual who has undergone the hemorrhage experiences a severe headache. The other signs of subarachnoid hemorrhage include vomiting and double vision (Fugate, and Rabinstein, 2015). Tamara vomits regularly and has a problem with her visual capacity.

Subarachnoid hemorrhage, plexus papillomas, and meningitis lead to the excessive production of CFC (Hayreh, 2016). Elevated ICP indicates the abnormities in the pressure difference between the cerebrospinal fluid and the veins. The pressure begins and spreads to the posterior part of the brain (Hayreh, 2016). The elevated pressure causes a severe headache to the patients. Moreover, an individual vomits to try to balance the pressure in the brain. The physicians consider the pressure to be high when it exceeds 50mmHg (Hayreh, 2016). The condition needs adequate medical attention. When checked at its latter stages, ICP can result in the apoptosis of the brain cells (Hayreh, 2016). Individuals should visit health facilities for regular check-up due to the complexity of the brain’s physiology.

ASAH guidelines

 Elevated ICP occurs as a result of hemorrhage in the brain cells. The symptoms of Subarachnoid Hemorrhage (SH) include confusion, vomiting, and Nausea. Tamara experiences severe vomiting after her accident (Thompson et al., 2015). Therefore, her condition concurs with the symptoms of SH. Patients with SH and SH also experiences; a headache, Numbness, and pain in their neck region (Thompson et al., 2015). The medical records of the patients such as accidents assist the physicians in the diagnosis process. Leo had no medical history; however, Tamara’s accident contributed directly to the SH.

ASAH Guidelines

Before carrying out the treatment, the physicians must find out about the causes of the bleeding. The caregivers must also monitor the seriousness of the brain damage. The patient acquires the treatment to rectify the pressure of the ICP (Thompson et al., 2015). A proper treatment halts the hemorrhage and corrects the brain damage. Furthermore, the regime stops the symptoms, thereby, preventing brain complications. The care providers should carry out a thorough treatment process to permanently cure the disease. Patients who have suffered for an extended period require an extended rehabilitation and recovery process.

Individuals who have hypertension and complications of the kidney are at the highest risks of ICP (Thompson et al., 2015). The anomalies of the kidney explain the increased urine output that Leo experienced. Individuals who smoke cigarette also have high chances of getting ICP (Pasarikovski et al., 2017). Idiopathic complications and head injury lead to the onset of SH and consequently ICP. The damage to Tamara made the physicians suspect that she was suffering from the two conditions. Moreover, aneurysm and arteriovascular abnormities also lead to the onset of the brain hemorrhage.

Infections that have the same symptoms as those of ICP include a Migraine, Meningitis, Stroke, and Encephalitis (Magni et al., 2015). Diagnosis involves the checking of a patient’s records and physical tests. Moreover, neurological tests are also essential before the onset of treatment. CT scan should indicate the bleeding area of the brain if an individual if a victim of ICP. MRA and MRI also test for the bleeding parts (Carney et al., 2017). Treatment includes a suggestion of bed rest for the patient. Moreover, the physician and the family members should monitor the symptoms of the disease. Ventilation and incubation also balance the pressure in the brain (Carney et al., 2017).

Surgery and medication are also regiments to correct ICP. The operation is necessary when trauma and aneurysm are the causes of the hemorrhage (Carney et al., 2017). The process halts the bleeding and heals the resulting wound (Carney et al., 2017). Medications prevent a headache and seizures (Carney et al., 2017). The prescribed drugs also regulate the flow of blood in the vessels and improve relaxation of the venous muscles (Carney et al., 2017). The clinicians should also recommend the recovery steps for the patient.

MTBI is Mild Traumatic Brain Injury. Both Tamara and Leo experienced the condition. The disease manifests as a result of memory loss after an accident. The patient gets confused after the accident and suffers from prolonged amnesia. Symptoms of MTBI include a headache, memory loss, and fatigue (Mangat et al., 2015). Moreover, the patient like Tamara feels irritated after the accident. The patient also has concentration problems after the brain infection. The physical signs include a headache, vomiting, nausea and blurred vision (Mangat et al., 2015). More symptoms are dizziness, Tinnitus and noise and light sensitivity (Mangat et al., 2015).

MTBI Guidelines

Behavioral symptoms of MTBI include depression, irritability, and fatigue. Moreover, the victim becomes anxious and drowsy (Kelly, Bishop, and Ercole, 2018). The patient also faces sleeping difficulties. The individual cannot concentrate for an extended period and even loses memory (Andrews et al., 2015). The physician checks the past medical record of the patient during diagnosis. An individual who has undergone trauma and unconsciousness has high chances of getting MTBI. The tolerance levels of the victim reduce towards alcohol.

The Family Escalation Care refers to a universal culture that the development and emotional needs of a child must include the presence of the family (Albutt et al., 2017). Therefore the healthcare systems must involve the family members in the treatment and management of a disease. Apart from the victim, the family members have to detect the symptoms of a condition that the victim is having. The family detects the health deterioration of the patient before visiting the hospital. The physicians must listen to the family members before administering treatment.

The family members have information that the diagnostic procedures may fail to detect. The hidden symptoms may also be missing from the clinical assumptions of the physician. It is the role of the relatives to reveal all the signs that the patient might have forgotten. The physicians must involve the family in planning for treatment (Johnston et al., 2015). The relatives have a vital role to play in decision making before treatment.  The family also has the duty of taking care of the patient after surgery. The rehabilitation process requires the presence of the family (Bucknall et al., 2015). The relatives should monitor the patient to ensure that they take the drugs as prescribed by the doctor.

In Leo and Tamara’s case studies, the family members have a vital role to play. Tamara’s father has to ensure that the daughter maintains the dosage from the doctor. Moreover, the family members should input on whether treatment should be through surgery or medication. ICP causes confusion and memory loss; therefore, family members should answer assessment questions on behalf of the patient. Furthermore, the memory disruption prevents the patient from stating all the symptoms and signs of the disease. The family members should indicate the signs and symptoms of the infection. The condition interferes with vision as it leads to blurred vision. The family members have a duty of aiding the victim in movement. The family should ensure that the sick members get enough bed rest after the treatment.

Conclusion

ICP occurs as a result of pressure in the brain cells. Tamara and Leo have the condition due to the symptoms that they exhibit. The primary symptoms of the disease are a severe headache, vomiting, difficulties in vision. The situation is as a result of the subarachnoid hemorrhage (SH) of the brain tissues. The ASAH guidelines elaborate the signs and symptoms of SH. Additionally, the instructions develop the signs and symptoms of the condition. The guidelines also assist physicians to carry out the diagnostic procedures.

The MTBI also formulates a guideline for the treatment of the tumors of the brain. Moreover, the guidelines elaborate the diagnosis, symptoms, and treatment of brain tumors. The family members have a critical role to play in the treatment of individuals having deteriorated health. The family members should take part in decision making before the procedure.

References

Albutt, A.K., O’Hara, J.K., Conner, M.T., Fletcher, S.J. and Lawton, R.J., 2017. Is there a role for patients and their relatives in escalating clinical deterioration in the hospital? A systematic review. Health Expectations, 20(5), pp.818-825.

Andrews, P.J., Sinclair, H.L., Rodriguez, A., Harris, B.A., Battison, C.G., Rhodes, J.K. and Murray, G.D., 2015. Hypothermia for intracranial hypertension after traumatic brain injury. New England Journal of Medicine, 373(25), pp.2403-2412.

Bucknall, T.K., Forbes, H., Phillips, N.M., Hewitt, N.A., Cooper, S., Bogossian, F. and First2Act Investigators, 2016. An analysis of nursing students’ decision?making in teams during simulations of acute patient deterioration. Journal of advanced nursing, 72(10), pp.2482-2494.

Carney, N., Totten, A.M., O’Reilly, C., Ullman, J.S., Hawryluk, G.W., Bell, M.J., Bratton, S.L., Chesnut, R., Harris, O.A., Kissoon, N. and Rubiano, A.M., 2017. Guidelines for the management of severe traumatic brain injury. Neurosurgery, 80(1), pp.6-15.

Fugate, J. E., and Rabinstein, A. A. 2015. Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions. The Lancet Neurology, 14(9), 914-925.

Hayreh, S. S. 2016. Pathogenesis of optic disc edema in raised intracranial pressure. Progress in retinal and eye research, 50, 108-144.

Johnston, M.J., Davis, R.E., Arora, S., King, D., Reiss, Y. and Darzi, A., 2015. Raising the alarm: A cross-sectional study exploring the factors affecting patients’ willingness to escalate care on surgical wards. World journal of surgery, 39(9), pp.2207-2213.

Kelly, S., Bishop, S.M. and Ercole, A., 2018. Statistical Signal Properties of the Pressure-Reactivity Index (PRx). In Intracranial Pressure & Neuromonitoring XVI (pp. 317-320). Springer, Cham.

Koziarz, A., Sne, N., Kegel, F., Alhazzani, W., Nath, S., Badhiwala, J. H., … and Kahnamoui, K. 2017. Optic nerve sheath diameter sonography for the diagnosis of increased intracranial pressure: a systematic review and meta-analysis protocol. BMJ Open, 7(8), e016194.

Magni, F., Pozzi, M., Rota, M., Vargiolu, A., and Citterio, G., 2015. High-resolution intracranial pressure burden and outcome in subarachnoid hemorrhage. Stroke, 46(9), pp.2464-2469.

Mangat, H.S., Chiu, Y.L., Gerber, L.M., Alimi, M., Ghajar, J. and Härtl, R., 2015. Hypertonic saline reduces cumulative and daily intracranial pressure burdens after severe traumatic brain injury. Journal of Neurosurgery, 122(1), pp.202-210

Pasarikovski, C. R., Alotaibi, N. M., Al-Mufti, F., and Macdonald, R. L., 2017. Hypertonic Saline for Increased Intracranial Pressure After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review. World neurosurgery, 105, 1-6.

Patterson, D. F., Ho, M. L., Leavitt, J. A., Smischney, N. J., Hocker, S. E., Wijdicks, E. F., … and Chen, J. J. W. 2018. Comparison of Ocular Ultrasonography and MRI for Detection of Increased Intracranial Pressure. Frontiers in neurology, 9, 278.

Thompson, B. G., Brown, R. D., Amin-Hanjani, S., Broderick, J. P., Cockroft, K. M., Connolly, E. S., … and Meyers, P. M. 2015. Guidelines for the management of patients with unruptured intracranial aneurysms: the guide for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 46(8), 2368-2400.

Wilson, M. H. 2016. Monro-Kellie 2.0: The dynamic vascular and venous pathophysiological components of intracranial pressure. Journal of Cerebral Blood Flow & Metabolism, 36(8), 1338-1350.