INTRACRANIAL HYPERTENSION IN PATIENTS WITH INTRACRANIAL HEMORRHAGE. DIAGNOSIS AND TREATMENT
Increase of intracranial pressure (ICP) in patients with intracranial hemorrhages leads to brain dislocation, brain strangulation and impairment of cerebral blood ﬂow as well as to signiﬁ cant worsening of outcome. Various methods are used for intracranial hypertension (ICH) diagnostics but the most accurate one is the direct measurement of ICP. ICH therapy is divided into background therapy and emergent one. Background therapy is focused on prophylaxis and elimination of factors which can worsen or force the development of ICH. This therapy includes optimization of venous drainage from skull cavity, sedation and analgesia as well as adequate respiratory support, hypothermia and hemodynamics correction.The “step-by-step” algorithm is used while preventive measures for ICP decrease are ineffective when ICP is more than 20 mmHg.This algorithm consists of emergent brain CT for detecting the surgical reasons for ICH, adjustable discharge of cerebrospinal ﬂ uid, hyperventilation and usage of hyperosmolar solutions. Medicated coma, artiﬁcial hypothermia and in-time decompressive craniotomy are used within progressively increase of ICH.