Low intracranial pressure syndrome after head injury

Low intracranial pressure syndrome after head injury.  The cause of intracranial hypotension may be caused by cerebral vasospasm after injury, which inhibits the function of the choroid plexus to secrete cerebrospinal fluid. It may also be secondary to cerebrospinal fluid leakage, shock, severe dehydration, hyponatremia, hyperventilation, and surgery or Lumbar puncture releases too much cerebrospinal fluid, etc.

The range of normal intracranial pressure, measured by lumbar puncture, should be between 7.84-11.8kPa (80~120mmH2O). In general, the intracranial pressure after head injury often rises to varying degrees, and there are fewer cases of low intracranial pressure. Sometimes, some patients have had intracranial pressure increase in the early post-injury period, and then have intracranial hypotension. Its incidence is about 5%. The so-called intracranial hypotension syndrome refers to the comprehensive syndrome caused by the patient’s lateral lumbar puncture pressure below 7.84 kPa.

The clinical manifestations are similar to the increase in intracranial pressure, only because of the different treatment methods, the distinction must be made carefully. The cause of intracranial hypotension may be caused by cerebral vasospasm after injury, which inhibits the function of the choroid plexus to secrete cerebrospinal fluid. It may also be secondary to cerebrospinal fluid leakage, shock, severe dehydration, hyponatremia, hyperventilation, and surgery or Lumbar puncture releases too much cerebrospinal fluid, etc. Headache after lumbar puncture is well-known.

The mechanism is the inhibition of choroid plexus reflex caused by the lumbar puncture itself or the dysfunction of the hypothalamic cerebrospinal fluid secretion center; the second is the decrease of cerebrospinal fluid volume.

Low intracranial pressure after trauma usually occurs 1-2 hours after the head injury, and sometimes the headache is the most prominent after 2-3 days. It is often located on the forehead and back occiput, and it aggravates with the elevation of the head. In severe cases, it spreads all over. Head side by side to the neck, back, shoulders, and even to the F limbs. When you lie down in a head-down position, the headache will be relieved or disappeared. The second is dizziness and vomiting. Dizziness, nausea, and vomiting occur every time the head position changes or after severe headaches.

Patients often have rapid pulse, low blood pressure, brightening, fatigue, anorexia, water loss, and neck stiffness. , In severe cases, disturbance of consciousness may occur, in mild cases, lethargy, in severe cases, coma. A small number of patients can still have autonomic symptoms, such as significant fluctuations in vital signs, paroxysmal flushing of the skin on the face and neck, and even individual patients lose the cerebrospinal fluid lifting and cushioning effect due to the brain tissue, causing the cranial nerves to be directly squeezed or involved The signs of pupil unequal size and/or abductor paralysis can easily be confused with increased intracranial pressure and should be vigilant.

The treatment of low intracranial pressure syndrome after trauma may be slightly different due to different causes, but the basic principles are the same.

The commonly used treatment methods are:

• rest on your back, sleepless pillows, if necessary, take your feet high and your head low; increase fluid intake Intake, daily orally or intravenously instill 1000ml of normal saline and about 2500~3000ml of 5% glucose solution;
• give oxygen containing 5% CO2 to inhale people, 5~10 minutes per hour, can make cerebral blood vessels dilate and resist Reduce and promote the secretion of cerebrospinal fluid;
• intravenous injection of distilled water 10-15 ml/day can reflexly stimulate the production of cerebrospinal fluid, but attention must be paid to hemolytic reaction;
• if necessary, 0.5% hypotonic saline 500-1000ml/day can be instilled. Increase the effect of cerebrospinal fluid; use 0.5% novcaine 10 ml to alternately seal the left and right cervical sympathetic ganglia, once a day, can dilate intracranial blood vessels;
• inject normal saline or filter air through the ventricle for 10~ 15 ml or intrathecal injection of 15-20 ml of saline or air via lumbar puncture can not only directly fill the subarachnoid space, but also stimulate the secretion of cerebrospinal fluid, but it has the disadvantage of residual puncture leakage after lumbar puncture;
• other Drugs that are beneficial to improve intracranial hypotension, such as papaverine, ephedrine, epinephrine, pituitrin, caffeine, pilocarpine, neostigmine, dextroamphetamine sulfate, urotropine and corticosteroids, etc.

Give it in an appropriate amount to promote its recovery. In addition, patients with secondary intracranial hypotension should be treated promptly according to the cause, for example, cerebrospinal fluid leakage repair.

The human nervous system is composed of the brain and spinal cord (called the central nervous system), cranial and spinal nerves (called the peripheral nervous system), and sympathetic and parasympathetic nerves (called the autonomic nervous system). It is the highest organ of the human body, dominating all human life activities.

In our daily diagnosis and treatment work, we deal with various diseases for patients with neurological diseases every day and answer questions related to their diseases.

On this basis, we organize the common questions raised by disease categories. It aims to provide guidance and help for the vast number of patients with the nervous system to seek medical advice!

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