nach oben

Erschienen in:

2015 | OriginalPaper | Buchkapitel

11. Erhöhter intrakranieller Druck

verfasst von : Jennifer Diedler, PD Dr., Nils Henninger, MD, Hagen Huttner, PD Dr.

Erschienen in: NeuroIntensiv

Verlag: Springer Berlin Heidelberg

Einloggen, um Zugang zu erhalten

Zusammenfassung

Der intrakranielle Druck (ICP) entspricht dem Druck innerhalb des knöchernen Gehirnschädels. Bei gesunden Erwachsenen liegt er, je nach Körperposition, bei 5−15 mmHg. Ein Anstieg des Volumens im intrakraniellen Raum führt zu einer Erhöhung des ICP. Daher beruhen letztlich alle konservativen Therapieansätze zur Reduktion des intrakraniellen Druckes auf einer Reduktion des intrakraniellen Volumens. Da eine Erhöhung des ICP rasch zum Tode führen kann, ist die frühe Diagnose und Behandlung entscheidend für den Therapieerfolg. Überwachung und Kontrolle der intrakraniellen Druckverhältnisse sind eine wesentliche Voraussetzung, um eine transtentorielle Einklemmung und das Auftreten sekundär ischämisch bedingter Hirnschäden zu verhindern. Einen ausreichenden CPP zu erhalten, ist hierbei besonders wichtig.

Alderson P, Roberts I (2005) Corticosteroids for acute traumatic brain injury. Cochrane Database Syst Rev CD000196

Anderson DC, Cranford RE (1979) Corticosteroids in ischemic stroke. Stroke 10:68–71CrossRefPubMed

Ayata C, Ropper AH (2002) Ischaemic brain oedema. J Clin Neurosci 9:113–124CrossRefPubMed

Bardutzky J, Schwab S (2007) Antiedema therapy in ischemic stroke. Stroke 38:3084–3094CrossRefPubMed

Bourgoin A, Albanese J, Wereszczynski N, Charbit M, Vialet R, Martin C (2003) Safety of sedation with ketamine in severe head injury patients: Comparison with sufentanil. Crit Care Med 31:711–717CrossRefPubMed

Busija DW, Leffler CW, Pourcyrous M (1988) Hyperthermia increases cerebral metabolic rate and blood flow in neonatal pigs. Am J Physiol 255:H343–346PubMed

Clifton GL, Valadka A, Zygun D, Coffey CS, Drever P, Fourwinds S et al (2011) Very early hypothermia induction in patients with severe brain injury (the national acute brain injury study: Hypothermia ii): A randomised trial. Lancet Neurol 10:131–139CrossRefPubMed

Cold GE (1990) Cerebral blood flow in acute head injury. The regulation of cerebral blood flow and metabolism during the acute phase of head injury, and its significance for therapy. Acta Neurochir Suppl (Wien) 49:1–64

Cooper DJ, Rosenfeld JV, Murray L, Arabi YM, Davies AR, D’Urso P et al (2011) Decompressive craniectomy in diffuse traumatic brain injury. New Engl J Med 364:1493–1502CrossRefPubMed

10.

Corbett D, Thornhill J (2000) Temperature modulation (hypothermic and hyperthermic conditions) and its influence on histological and behavioral outcomes following cerebral ischemia. Brain Pathol 10:145–152CrossRefPubMed

11.

Cottrell JE, Patel K, Turndorf H, Ransohoff J (1978) Intracranial pressure changes induced by sodium nitroprusside in patients with intracranial mass lesions. J Neurosurg 48:329–331CrossRefPubMed

12.

Curley G, Kavanagh BP, Laffey JG (2010) Hypocapnia and the injured brain: More harm than benefit. Crit Care Med 38:1348–1359CrossRefPubMed

13.

Diringer MN, Zazulia AR (2004) Osmotic therapy: Fact and fiction. Neurocrit Care 1:219–233CrossRefPubMed

14.

Durward QJ, Amacher AL, Del Maestro RF, Sibbald WJ (1983) Cerebral and cardiovascular responses to changes in head elevation in patients with intracranial hypertension. J Neurosurg 59:938–944CrossRefPubMed

15.

Eisenberg HM, Frankowski RF, Contant CF, Marshall LF, Walker MD (1988) High–dose barbiturate control of elevated intracranial pressure in patients with severe head injury. J Neurosurg 69:15–23CrossRefPubMed

16.

Fishman RA (1975) Brain edema. N Engl J Med 293:706–711CrossRefPubMed

17.

Fishman RA (1980) Cerebrospinal fluid in diseases of the nervous system. Saunders, Philadelphia

18.

Frick H, Leonhardt H, Starck D (1982) Hirn- und Rückenmarkshäute. Taschenlehrbuch der gesamten Anatomie. Spezielle Anatomie I. Thieme, New York, S 158–164

19.

Gabor AJ, Brooks AG, Scobey RP, Parsons GH (1984) Intracranial pressure during epileptic seizures. Electroencephalogr Clin Neurophysiol 57:497–506CrossRefPubMed

20.

Galich JM, French LA (1961) Use of dexamethasone in the treatment of cerebral edema resulting from brain tumors and brain surgery. Am Pract Dig Treat 12:169–174

21.

Greenberg MS (1997) Intracranial pressure. Handbook of neurosurgery. Greenberg Graphics, Lakeland, Florida, S 704–721

22.

Guidelines for the management of severe traumatic brain injury (2007) J Neurotrauma 24 (Suppl 1): S1–106

23.

Hauer EM, Stark D, Staykov D, Steigleder T, Schwab S, Bardutzky J (2011) Early continuous hypertonic saline infusion in patients with severe cerebrovascular disease. Crit Care Med 39:1766–1772CrossRefPubMed

24.

Hertle DN, Dreier JP, Woitzik J, Hartings JA, Bullock R, Okonkwo DO et al (2012) Effect of analgesics and sedatives on the occurrence of spreading depolarizations accompanying acute brain injury. Brain 135:2390–2398CrossRefPubMed

25.

Hoff JT (1986) Cerebral protection. J Neurosurg 65:579–591CrossRefPubMed

26.

Hofmeijer J, Kappelle LJ, Algra A, Amelink GJ, van Gijn J, van der Worp HB (2009) Surgical decompression for space-occupying cerebral infarction (the hemicraniectomy after middle cerebral artery infarction with life–threatening edema trial [hamlet]): A multicentre, open, randomised trial. Lancet Neurol 8:326–333CrossRefPubMed

27.

Hutchinson P, Timofeev I, Kirkpatrick P (2007) Surgery for brain edema. Neurosurg Focus 22:E14CrossRefPubMed

28.

Huttner HB, Schwab S (2009) Malignant middle cerebral artery infarction: Clinical characteristics, treatment strategies, and future perspectives. Lancet Neurol 8:949–958CrossRefPubMed

29.

Imberti R, Bellinzona G, Langer M (2002) Cerebral tissue po₂ and sjvo₂ changes during moderate hyperventilation in patients with severe traumatic brain injury. J Neurosurg 96:97–102CrossRefPubMed

30.

Inao S, Kuchiwaki H, Wachi A, Andoh K, Nagasaka M, Sugita K, Furuse M (1990) Effect of mannitol on intracranial pressure–volume status and cerebral haemodynamics in brain oedema. Acta Neurochir Suppl (Wien) 51:401–403

31.

Juttler E, Schellinger PD, Aschoff A, Zweckberger K, Unterberg A, Hacke W (2007) Clinical review: Therapy for refractory intracranial hypertension in ischaemic stroke. Crit Care 11:231CrossRefPubMedPubMedCentral

32.

Juttler E, Schweickert S, Ringleb PA, Huttner HB, Kohrmann M, Aschoff A (2009) Long–term outcome after surgical treatment for space–occupying cerebellar infarction: Experience in 56 patients. Stroke 40:3060–3066CrossRefPubMed

33.

Juttler E, Unterberg A, Woitzik J, Bosel J, Amiri H, Sakowitz OW et al (2014) Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke. New Engl J Med 370:1091–1100CrossRefPubMed

34.

Kaufmann AM, Cardoso ER (1992) Aggravation of vasogenic cerebral edema by multiple–dose mannitol. J Neurosurg 77:584–589CrossRefPubMed

35.

Kempski O (2005) Hypertonic saline and stroke. Crit Care Med 33:259–260CrossRefPubMed

36.

Kim MY, Park JH, Kang NR, Jang HR, Lee JE, Huh W et al (2014) Increased risk of acute kidney injury associated with higher infusion rate of mannitol in patients with intracranial hemorrhage. J Neurosurg 120:1340–1348CrossRefPubMed

37.

Kollmar R, Staykov D, Dorfler A, Schellinger PD, Schwab S, Bardutzky J (2010) Hypothermia reduces perihemorrhagic edema after intracerebral hemorrhage. Stroke 41:1684–1689CrossRefPubMed

38.

Lassen NA (1974) Control of cerebral circulation in health and disease. Circ Res 34:749–760CrossRefPubMed

39.

Lassen NA, Christensen M (1976) Physiology of cerebral blood flow. Br J Anaesth 48:719–734CrossRefPubMed

40.

Marino PL (2002) Analgosedierung. Praktische intensivmedizin. Urban und Fischer, München, Jena, S 87–97

41.

Marion DW, Puccio A, Wisniewski SR, Kochanek P, Dixon CE, Bullian L, Carlier P (2002) Effect of hyperventilation on extracellular concentrations of glutamate, lactate, pyruvate, and local cerebral blood flow in patients with severe traumatic brain injury. Crit Care Med 30:2619–2625CrossRefPubMed

42.

Mathew P, Teasdale G, Bannan A, Oluoch–Olunya D (1995) Neurosurgical management of cerebellar haematoma and infarct. J Neurol Neurosurg Psychiatry 59:287–292CrossRefPubMedPubMedCentral

43.

Misra UK, Kalita J, Ranjan P, Mandal SK (2005) Mannitol in intracerebral hemorrhage: A randomized controlled study. J Neurol Sci 234:41–45CrossRefPubMed

44.

Mortazavi MM, Romeo AK, Deep A, Griessenauer CJ, Shoja MM, Tubbs RS et al (2012) Hypertonic saline for treating raised intracranial pressure: Literature review with meta-analysis. J Neurosurg 116:210–221CrossRefPubMed

45.

Mourvillier B, Tubach F, van de Beek D, Garot D, Pichon N, Georges H et al (2013) Induced hypothermia in severe bacterial meningitis: A randomized clinical trial. JAMA 310:2174–2183CrossRefPubMed

46.

Muizelaar JP, Wei EP, Kontos HA, Becker DP (1983) Mannitol causes compensatory cerebral vasoconstriction and vasodilation in response to blood viscosity changes. J Neurosurg 59:822–828CrossRefPubMed

47.

Muizelaar JP, Marmarou A, Ward JD, Kontos HA, Choi SC, Becker DP, Gruemer H, Young HF (1991) Adverse effects of prolonged hyperventilation in patients with severe head injury: A randomized clinical trial. J Neurosurg 75:731–739CrossRefPubMed

48.

Murphy PG, Myers DS, Davies MJ, Webster NR, Jones JG (1992) The antioxidant potential of propofol (2,6–diisopropylphenol). Br J Anaesth 68:613–618CrossRefPubMed

49.

Nagao S, Kitaoka T, Fujita K, Kuyama H, Ohkawa M (1996) Effect of tris–(hydroxymethyl)–aminomethane on experimental focal cerebral ischemia. Exp Brain Res 111:51–56CrossRefPubMed

50.

Nwachuku EL, Puccio AM, Fetzick A, Scruggs B, Chang YF, Shutter LA et al (2014) Intermittent versus continuous cerebrospinal fluid drainage management in adult severe traumatic brain injury: Assessment of intracranial pressure burden. Neurocrit care 20:49–53CrossRefPubMed

51.

Paczynski RP, He YY, Diringer MN, Hsu CY (1997) Multiple–dose mannitol reduces brain water content in a rat model of cortical infarction. Stroke 28:1437–1443 (discussion 1444)CrossRefPubMed

52.

Perner A, Haase N, Guttormsen AB, Tenhunen J, Klemenzson G, Aneman A et al (2012) Hydroxyethyl starch 130/0.42 versus ringer’s acetate in severe sepsis. New Engl J Med 367:124–134CrossRefPubMed

53.

Poungvarin N, Bhoopat W, Viriyavejakul A, Rodprasert P, Buranasiri P, Sukondhabhant S, Hensley MJ, Strom BL (1987) Effects of dexamethasone in primary supratentorial intracerebral hemorrhage. N Engl J Med 316:1229–1233CrossRefPubMed

54.

Ramnarayan R, Anto D, Anilkumar TV, Nayar R (2009) Decompressive hemicraniectomy in large putaminal hematomas: An indian experience. J Stroke Cerebrovasc Dis 18:1–10CrossRefPubMed

55.

Rangel-Castilla L, Lara LR, Gopinath S, Swank PR, Valadka A, Robertson C (2010) Cerebral hemodynamic effects of acute hyperoxia and hyperventilation after severe traumatic brain injury. J Neurotrauma 27:1853–1863CrossRefPubMedPubMedCentral

56.

Righetti E, Celani MG, Cantisani T, Sterzi R, Boysen G, Ricci S (2004) Glycerol for acute stroke. Cochrane Database Syst Rev 2004:CD000096

57.

Roberts I, Sydenham E (2012) Barbiturates for acute traumatic brain injury. Cochrane database Syst Rev 12:CD000033PubMed

58.

Rockoff MA, Marshall LF, Shapiro HM (1979) High–dose barbiturate therapy in humans: A clinical review of 60 patients. Ann Neurol 6:194–199CrossRefPubMed

59.

Ropper AH (1993) Treatment of intracranial hypertension. Neurological and neurosurgical intensive care. Raven Press, New York, S 29–52

60.

Ropper AH (2012) Hyperosmolar therapy for raised intracranial pressure. New Engl J Med 367:746–752CrossRefPubMed

61.

Ropper AH, Brown RH (2005) Adams and victor´s principles of neurology. McGraw–Hill, New York

62.

Ropper AH, O’Rourke D, Kennedy SK (1982) Head position, intracranial pressure, and compliance. Neurology 32:1288–1291CrossRefPubMed

63.

Rosenburg GA (1990) Brain fluids and metabolism. Oxford University Press, Oxford

64.

Rosner MJ, Coley IB (1986) Cerebral perfusion pressure, intracranial pressure, and head elevation. J Neurosurg 65:636–641CrossRefPubMed

65.

Rosner MJ, Rosner SD, Johnson AH (1995) Cerebral perfusion pressure: Management protocol and clinical results. J Neurosurg 83:949–962CrossRefPubMed

66.

Schwab S, Spranger M, Schwarz S, Hacke W (1997) Barbiturate coma in severe hemispheric stroke: Useful or obsolete? Neurology 48:1608–1613CrossRefPubMed

67.

Schwab S, Erbguth F, Aschoff A, Orberk E, Spranger M, Hacke W (1998) „Paradoxical“ Herniation after decompressive trephining. Nervenarzt 69:896–900CrossRefPubMed

68.

Schwab S, Schwarz S, Bertram M, Spranger M, Hacke W (1999) Moderate hypothermia for the treatment of malignant middle cerebral artery infarct. Nervenarzt 70:539–546CrossRefPubMed

69.

Schwarz S, Schwab S, Bertram M, Aschoff A, Hacke W (1998) Effects of hypertonic saline hydroxyethyl starch solution and mannitol in patients with increased intracranial pressure after stroke. Stroke 29:1550–1555CrossRefPubMed

70.

Schwarz S, Georgiadis D, Aschoff A, Schwab S (2002) Effects of hypertonic (10 %) saline in patients with raised intracranial pressure after stroke. Stroke 33:136–140CrossRefPubMed

71.

Shackford SR (1990) Analytic reviews: Fluid resuscitation in head injury. J Intensive Care Med 5:59–68CrossRef

72.

Simard JM, Kent TA, Chen M, Tarasov KV, Gerzanich V (2007) Brain oedema in focal ischaemia: Molecular pathophysiology and theoretical implications. Lancet Neurol 6:258–268CrossRefPubMedPubMedCentral

73.

Staykov D, Huttner HB, Kollmar R, Ganslandt O, Doerfler A, Schwab S, Kohrmann M (2010) When decompressive craniectomy does not lead to decompression: Sinking skin flap syndrome after intracerebral hemorrhage. Eur Neurol 64:319CrossRefPubMed

74.

Staykov D, Wagner I, Volbers B, Doerfler A, Schwab S, Kollmar R (2013) Mild prolonged hypothermia for large intracerebral hemorrhage. Neurocritical care 18:178–183CrossRefPubMed

75.

Steiner T, Pilz J, Schellinger P, Wirtz R, Friederichs V, Aschoff A, Hacke W (2001) Multimodal online monitoring in middle cerebral artery territory stroke. Stroke 32:2500–2506CrossRefPubMed

76.

Steiner T, Ringleb P, Hacke W (2001) Treatment options for large hemispheric stroke. Neurology 57:61–68CrossRef

77.

Stocchetti N, Maas AI, Chieregato A, van der Plas AA (2005) Hyperventilation in head injury: A review. Chest 127:1812–1827CrossRefPubMed

78.

Strandgaard (1976) Autoregulation of cerebral blood flow in hypertensive patients. The modifying influence of prolonged antihypertensive treatment on the tolerance to acute, drug–induced hypotension. Circulation 53:720–727CrossRefPubMed

79.

Strandgaard S, Paulson OB (1984) Cerebral autoregulation. Stroke 15:413–416CrossRefPubMed

80.

Strandvik GF (2009) Hypertonic saline in critical care: A review of the literature and guidelines for use in hypotensive states and raised intracranial pressure. Anaesthesia 64:990–1003CrossRefPubMed

81.

Thomalla G, Hartmann F, Juettler E, Singer OC, Lehnhardt FG, Kohrmann M et al (2010) Prediction of malignant middle cerebral artery infarction by magnetic resonance imaging within 6 hours of symptom onset: A prospective multicenter observational study. Ann Neurol 68:435–445CrossRefPubMed

82.

Tinker JH, Michenfelder JD (1976) Sodium nitroprusside: Pharmacology, toxicology and therapeutics. Anesthesiology 45:340–354CrossRefPubMed

83.

Toung TJ, Chen CH, Lin C, Bhardwaj A (2007) Osmotherapy with hypertonic saline attenuates water content in brain and extracerebral organs. Crit Care Med 35:526–531CrossRefPubMed

84.

Vahedi K, Hofmeijer J, Juettler E, Vicaut E, George B, Algra A, Amelink GJ, Schmiedeck P, Schwab S, Rothwell PM, Bousser MG, van der Worp HB, Hacke W (2007) Early decompressive surgery in malignant infarction of the middle cerebral artery: A pooled analysis of three randomised controlled trials. Lancet Neurol 6:215–222CrossRefPubMed

85.

van der Worp HB, Macleod MR, Bath PM, Demotes J, Durand-Zaleski I, Gebhardt B et al (2014) Eurohyp-1: European multicenter, randomized, phase iii clinical trial of therapeutic hypothermia plus best medical treatment vs. Best medical treatment alone for acute ischemic stroke. Int J Stroke 9:642–645CrossRefPubMed

86.

Videen TO, Zazulia AR, Manno EM, Derdeyn CP, Adams RE, Diringer MN, Powers WJ (2001) Mannitol bolus preferentially shrinks non–infarcted brain in patients with ischemic stroke. Neurology 57:2120–2122CrossRefPubMed

87.

Wakai A, McCabe A, Roberts I, Schierhout G (2013) Mannitol for acute traumatic brain injury. Cochrane database Syst Rev 8:CD001049PubMed

88.

Walcott BP, Kahle KT, Simard JM (2012) Novel treatment targets for cerebral edema. Neurotherapeutics 9:65–72CrossRefPubMed

89.

Wijdicks EF, Sheth KN, Carter BS, Greer DM, Kasner SE, Kimberly WT et al (2014) Recommendations for the management of cerebral and cerebellar infarction with swelling: A statement for healthcare professionals from the american heart association/american stroke association. Stroke 45:1222–1238CrossRefPubMed

90.

Wolf AL, Levi L, Marmarou A, Ward JD, Muizelaar PJ, Choi S, Young H, Rigamonti D, Robinson WL (1993) Effect of tham upon outcome in severe head injury: A randomized prospective clinical trial. J Neurosurg 78:54–59CrossRefPubMed

91.

Woodcock J, Ropper AH, Kennedy SK (1982) High dose barbiturates in non–traumatic brain swelling: Icp reduction and effect on outcome. Stroke 13:785–787CrossRefPubMed

92.

Yoshida K, Marmarou A (1991) Effects of tromethamine and hyperventilation on brain injury in the cat. J Neurosurg 74:87–96CrossRefPubMed

93.

Zeiler FA, Teitelbaum J, Gillman LM, West M (2014) Tham for control of icp. Neurocrit Care (E publishing Apr 2014)

Titel: Erhöhter intrakranieller Druck
verfasst von: Jennifer Diedler, PD Dr.
Nils Henninger, MD
Hagen Huttner, PD Dr.
Verlag: Springer Berlin Heidelberg
Buch: NeuroIntensiv
Print ISBN: 978-3-662-46499-1

Electronic ISBN: 978-3-662-46500-4

Copyright-Jahr: 2015
DOI: https://doi.org/10.1007/978-3-662-46500-4_11

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Springer Medizin

11. Erhöhter intrakranieller Druck

Zusammenfassung

Neu im Fachgebiet AINS

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

Hinter dieser Appendizitis steckte ein Erreger

Ärztliche Empathie hilft gegen Rückenschmerzen

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

Update AINS

Springer Medizin

Zusammenfassung

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Neu im Fachgebiet AINS

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

Hinter dieser Appendizitis steckte ein Erreger

Ärztliche Empathie hilft gegen Rückenschmerzen

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

Update AINS