Posts Tagged brain tumor
Increased intracranial pressure is a medical term that refers to growing pressure inside a person’s skull. This pressure can affect the brain if doctors do not treat it.
A sudden increase in the pressure inside a person’s skull is a medical emergency. Left untreated, an increase in the intracranial pressure (ICP) may lead to brain injury, seizure, coma, stroke, or death.
With prompt treatment, it is possible for people with increased ICP to make a full recovery.
In this article, we look at the symptoms, causes, and treatments of increased ICP.
Symptoms of increased ICP
The symptoms of increased ICP can vary depending on a person’s age.
Infants with increased ICP may have different symptoms to older children or adults with the condition, as discussed below.
Symptoms in adults
- pupils that do not respond to light in the usual way
- behavior changes
- reduced alertness
- muscle weakness
- speech or movement difficulties
- blurred vision
As raised ICP progresses, a person may lose consciousness and go into a coma. High ICP may cause brain damage if a person does not receive emergency treatment.
Symptoms in infants
Infants with increased ICP may show some of the same symptoms as adults. In addition, the shape of their heads may be affected.
Infants still have soft plates in their skull that fibrous tissue called skull sutures knit together. Increased ICP may cause the skull sutures to separate and the soft plates to move apart.
Increased ICP in infants may also cause their fontanel to bulge out. The fontanel is the soft spot on the top of the skull.
The following is a list of medical conditions and other causes that can lead to increased ICP:
- brain injury, which is often the result of a blow to the head
- hydrocephalus, or too much cerebrospinal fluid on the brain
- brain swelling
- bleeding or blood pooling in the brain
- brain aneurysm
- brain infection, such as meningitis or encephalitis
- high blood pressure
- brain tumor
- drug interaction
- hypoxemia, a blood oxygen deficiency
In infants, high ICP may be the result of child abuse.
If a person handles a baby or infant too roughly, it may cause them to develop a brain injury. This is known as shaken baby syndrome.
One source has estimated that between 1,000 and 3,000 children in the United States experience shaken baby syndrome each year. The condition may arise if an adult shakes a baby violently to stop them crying.
Anyone who suspects a child may be experiencing abuse can contact the National Child Abuse Hotline anonymously at 1-800-4-A-CHILD (1-800-422-4453).
If a person has the symptoms of increased ICP, they should see a doctor straight away. This is a medical emergency and may lead to brain injury if a person does not receive rapid treatment.
A doctor will measure the ICP in millimeters of mercury (mm/Hg). The normal range is less than 20 mm/Hg. When ICP goes above this, a person may be experiencing increased ICP.
To diagnose increased ICP, a doctor may ask if a person has:
- experienced a blow to a head
- a previous diagnosis of a brain tumor
Then, the doctor may carry out the following tests:
- neurological exam to test a person’s senses, balance, and mental state
- spinal tap that measures cerebrospinal fluid pressure
- CT scan that produces images of the head and brain
After these initial tests, the doctor may use an MRI scan to examine a person’s brain tissue in more detail.
If a person has a diagnosis of increased ICP, a doctor will immediately work to reduce the pressure inside the skull to lessen the risk of brain damage. They will then work to treat the underlying cause of the increased pressure.
Treatment methods for reducing ICP include:
- draining the excess cerebrospinal fluid with a shunt, to reduce pressure on the brain that hydrocephalus has caused
- medication that reduces brain swelling, such as mannitol and hypertonic saline
- surgery, less commonly, to remove a small section of the skull and relieve the pressure
A doctor may give the person a sedative to help reduce anxiety and lower their blood pressure. The person may also need breathing support. The doctor will monitor their vital signs throughout their treatment.
In rare cases, the doctor may put a person with high ICP into a medically induced coma to treat their condition.
Complications of increased ICP include:
- brain damage
Without proper treatment, increased ICP can be fatal.
A sudden increase in ICP is a medical emergency and can be life-threatening. The sooner a person receives treatment, the better their outlook. Many people respond well to treatment, and a person who has experienced increased ICP can make a full recovery.
Preventing increased ICP and its complications
Increased ICP is not always preventable, but it is possible to reduce the risk of some underlying conditions that may lead to increased ICP. We explore how below.
A person can reduce ther risk of stroke by exercising regularly.
Stroke may cause increased ICP. A person can reduce their risk of stroke in the following ways:
- taking steps to lower high blood pressure
- stopping smoking
- managing blood sugar levels
- controlling cholesterol levels
- exercising regularly
High blood pressure
High blood pressure may cause increased ICP. A person can maintain healthy blood pressure by:
- losing weight if overweight or maintaining a healthy weight
- avoiding drugs that increase blood pressure
- eating a healthful, balanced diet
- reducing salt intake
- exercising regularly
A head injury may cause increased ICP. Some examples of how a person can reduce their risk of head injury include:
- avoiding extreme sports or dangerous activities
- always wearing a helmet for activities such as riding a bike
- always wearing a seatbelt when in a car
Increased ICP is when the pressure inside a person’s skull increases. When this happens suddenly, it is a medical emergency. The most common cause of high ICP is a blow to the head.
The main symptoms are headache, confusion, decreased alertness, and nausea. A person’s pupils may not respond to light in the usual way.
A person with increased ICP may need urgent treatment. The immediate aim of treatment is to bring down the pressure on their brain tissue, which helps to reduce the risk of brain damage.
Without proper treatment, this condition may lead to seizure, coma, stroke, or brain damage. In severe cases, increased ICP can be fatal. Rapid treatment may improve a person’s outlook. Making a full recovery with timely treatment is possible.
Increased ICP is not always preventable, but a person can reduce their risk of some causes through lifestyle changes.
[Abstract] Intracranial EEG analysis in tumor-related epilepsy: Evidence of distant epileptic abnormalities – Clinical Neurophysiology
- In most patients with TRE, at least part of SOSz lies distant from the tumor.
- Resection of the brain tumor plus SOSz results in excellent seizure outcome.
- On iEEG, interictal spikes are most abundant and sharpest in the peritumoral region.
Objective: In patients with tumor-related epilepsy (TRE), surgery traditionally focuses on tumor resection; but identification and removal of associated epileptogenic zone may improve seizure outcome. Here, we study spatial relationship of tumor and seizure onset and early spread zone (SOSz). We also perform quantitative analysis of interictal epileptiform activities in patients with both TRE and non-lesional epilepsy in order to better understand the electrophysiological basis of epileptogenesis.
Methods: Twenty-five patients (11 with TRE and 14 with non-lesional epilepsy) underwent staged surgery using intracranial electrodes. Tumors were outlined on MRI and images were coregistered with post-implantation CT images. For each electrode, distance to the nearest tumor margin was measured. Electrodes were categorized based on distance from tumor and involvement in seizure. Quantitative EEG analysis studying frequency, amplitude, power, duration and slope of interictal spikes was performed.
Results: At least part of the SOSz was located beyond 1.5 cm from the tumor margin in 10/11 patients. Interictally, spike frequency and power were higher in the SOSz and spikes near tumor were smaller and less sharp. Interestingly, peritumoral electrodes had the highest spike frequencies and sharpest spikes, indicating greatest degree of epileptic synchrony. A complete resection of the SOSz resulted in excellent seizure outcome.
Conclusions: Seizure onset and early spread often involves brain areas distant from the tumor.
Significance: Utilization of epilepsy surgery approach for TRE may provide better seizure outcome and study of the intracranial EEG may provide insight into pathophysiology of TRE.
[ARTICLE] Changing the clinical course of glioma patients by preoperative motor mapping with navigated transcranial magnetic brain stimulation – Full Text
Background: Mapping of the motor cortex by navigated transcranial magnetic stimulation (nTMS) can be used for preoperative planning in brain tumor patients. Just recently, it has been proven to actually change outcomes by increasing the rate of gross total resection (GTR) and by reducing the surgery-related rate of paresis significantly in cohorts of patients suffering from different entities of intracranial lesions. Yet, we also need data that shows whether these changes also lead to a changed clinical course, and can also be achieved specifically in high-grade glioma (HGG) patients.
Methods: We prospectively enrolled 70 patients with supratentorial motor eloquently located HGG undergoing preoperative nTMS (2010–2014) and matched these patients with 70 HGG patients who did not undergo preoperative nTMS (2007–2010).
Results: On average, the overall size of the craniotomy was significantly smaller for nTMS patients when compared to the non-nTMS group (nTMS: 25.3 ± 9.7 cm2; non-nTMS: 30.8 ± 13.2 cm2; p = 0.0058). Furthermore, residual tumor tissue (nTMS: 34.3%; non-nTMS: 54.3%; p = 0.0172) and unexpected tumor residuals (nTMS: 15.7%; non-nTMS: 32.9%; p = 0.0180) were less frequent in nTMS patients. Regarding the further clinical course, median inpatient stay was 12 days for the nTMS and 14 days for the non-nTMS group (nTMS: CI 10.5 – 13.5 days; non-nTMS: CI 11.6 – 16.4 days; p = 0.0446). 60.0% of patients of the nTMS group and 54.3% of patients of the non-nTMS group were eligible for postoperative chemotherapy (OR 1.2630, CI 0.6458 – 2.4710, p = 0.4945), while 67.1% of nTMS patients and 48.6% of non-nTMS patients received radiotherapy (OR 2.1640, CI 1.0910 – 4.2910, p = 0.0261). Moreover, 3, 6, and 9 months survival was significantly better in the nTMS group (p = 0.0298, p = 0.0015, and p = 0.0167).
Conclusions: With the limitations of this study in mind, our data show that HGG patients might benefit from preoperative nTMS mapping.
[ARTICLE] Effect of Virtual Reality-Based Rehabilitation on Upper-Extremity Function in Patients with Brain Tumor: Controlled Trial.
…Virtual reality-based rehabilitation combined with conventional occupational therapy may be more effective than conventional occupational therapy, especially for proximal upper-extremity function in patients with brain tumor. Further studies considering hand function, such as use of virtual reality programs that targeting hand use, are required…