Intercranial Blood Pressure --- Causes
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Last updated June 2, 2017 (originally published October 7, 2015)

By Joseph Strongoli, Featured Columnist

[Health and fitness articles are reviewed by our team of Registered
Nurses, Certified fitness trainers and other members of our Editorial
Board.]





A pounding, sharp headache that originates behind the
eyes, and twinges with every eye movement. A ringing in
the ears, that intensifies with every heartbeat. Blurred,
dimmed, and doubled vision, light flashes and even brief
episodes of blindness that get progressively longer.
Nausea, vomiting, and dizziness. Neck, shoulder, and back
pain.

No, your head is not being crushed by a vice, although it
may feel like it is. These are the symptoms of idiopathic
intercranial hypertension (blood pressure in your head),
and if you suspect you might be suffering from this
condition, seek medical attention as soon as possible:

  • headaches
  • blurred vision
  • vomiting
  • drowsiness
  • buzzing in the ears
  • stumbling gait
  • numbness



Idiopathic intracranial hypertension (IIH), also known by
other names "pseudotumor cerebri" "empty sella syndrome"
and ", "benign intracranial hypertension", is a neurological
condiion in which the pressure inside your skull
(intracranial pressure) increases for no apparent,
discernible reason.



What Causes Idiopathic Intercranial Hypertension?



There are a number of conditions, such as brain tumors,
that increase intracranial pressure (ICP), but as its name
suggests, (idiopathic means “of unknown cause”)
intercranial hypertension occurs when the pressure in your
cranium reaches dangerous levels, for as yet unknown
causes. Studies suggest that it may be linked to an excess
amount of cerebrospinal fluid, a fluid that insulates and
protects your brain and spinal cord.



Because your cranium is a sealed environment, your
intracranial pressure increases when the amount of matter
in your skull exceeds its volume capacity. This is why
growths like brain tumors increase your intracranial
pressure, becauses there’s no room to accommodate the
tumor, and no way to relieve the mounting pressure. The
same thing happens if your brain swells, or if you have an
excess of cerebrospinal fluid.



The increased pressure associated with intercranial
hy
pertension can also cause other complications, such as
swelling of the optic nerve and optic disc (a condition called
"papilledema"), which can lead to vision impairment and
even blindness.


Intercranial hypertension is also an "important factor in the
progression of glaucoma", according to a 2015 Mayo Clinic
study led by Dr. Michael P. Fautsch.


[Editor's Note:

Intercranial hypertension is not the same as "exploding
head syndrome", though the two conditions can occur at
the same time. In one case study of the syndrome,
researchers found that the patient also had very high blood
pressure. With exploding head syndrome, patient's awake
to the sound of a loud exploding noise and can experience
severe headaches. The study was conducted in 2013 by
doctors from  Los Angeles County Medical Center,
University of Southern California – Keck School of
Medicine.]



Who Is At Risk?



























Research strongly suggests that intercranial hypertension is
correlated with
obesity, and is distributed unevenly
towards women.

A 2014 Mayo Clinic report noted that while idiopathic
intercranial hypertension has an overall incidence rate of 1
to 2 people in 100,000 in the general population, that
number jumps to 4 to 21 in 100,000 in obese women.



According to a 1999 study at the University of Liverpool,  
70.5% of intercranial hypertension patients were obese,
and the relative risk for obesity and IIH was at 8. This
number increased to 17 for obese females aged 16 to 24
years and 10 for obese females aged 25 to 34 years.
Morbid obesity was significantly associated with poor visual
outcome. The study concluded that, while obesity  is
unlikely to be the sole cause of high blood pressure in your
brain, they noted that obesity is highly likely to be a
precipitating factor.

Other risk factors for developing intercranial hyertension
include certain medications, such as growth hormones,
tetracycline, and
excess Vitamin A, and a handful of other
conditions such as
anemia, sleep apnea, lupus, blood-
clotting disorders, and Addison’s disease.

Because the underlying causes for intercranial hypertension
are still unclear, treatment focuses on alleviating the
symptoms and the mechanical alteration of the anatomy in
question.




1.     
Lumbar Puncture

The first step in symptom control for intercranial
hypertension is drainage of the cerebrospinal fluid (CSF)
via lumbar puncture, also known as a spinal tap.

Doctors insert a long needle into your back, accessing your
spinal column and draining some of the fluid.

According to a 1998 study at Guy’s Hospital, London, in
some mild cases a lumbar puncture alone is sufficient to
treat intercranial hypertension symptoms, and no further
treatment is needed.

The procedure can also be repeated if necessary, but if
repetition is necessary it’s usually a sign that additional
treatments are required to control symptoms and preserve
vision. Repeated lumbar punctures are sometimes
necessary to control intracranial pressure if a patient’s
vision is rapidly deteriorating.



2.     
Glaucoma medication

The next line of defense against intercranial hypertension is
acetazolamide, or Diamox as it’s known on the market.

Normally used to treat glaucoma, a February 2014 Mayo
Clinic report found that acetazolamide is also effective in
treating intercranial hypertensiom --- symptoms were
improved in 47-67% of patients.  

The drug works to reduce the production of cerebrospinal
fluid up to 57 percent, thus alleviating the pressure build-
up in the brain. Side effects include upset stomach, fatigue,
a tingling sensation in the fingers, toes, and mouth, and
kidney stones.



3.     
Diuretics

According to the 2014 Mayo Clinic report from above,
sometimes acetazolamide

treatment is supplemented with furosemide (Lasix), a
powerful diuretic that diminishes fluid retention by
increasing your urine output.  The dual treatment reduces
the fluid pressure built up in the cranium by reducing
cerebral spinal fluid production and by flushing fluids out
through the urinary system.



4.     
Migraine Meds

A number of analgesics (painkillers) are also used to treat
the headaches that intercranial hypertension inflicts.

A 2006 study at the National Hospital for Neurology and
Neurosurgery in London found that in addition to
conventional painkillers such as paracetamol, low doses of
the antidepressant amitriptyline or the anti-convulsant
topiramate have proven effective in relieving intercranial
hypertension headache symptoms.



5.     Optic Nerve Sheath Fenestration


This is a procedure in which your surgeon cuts a small
opening into the membrane that surrounds the optic nerve,
allowing excess cerebrospinal fluid to drain out. In most
cases, this procedure causes vision to improve or at least
stabilize.

Most patients who have this operation done to one eye
notice a benefit for both eyes.  However, the surgery isn’t
always successful, and there is a chance that vision
problems may increase. In fact, there is a 1-2% chance
that the patient could go blind, according to a 2004 study
at UC San Francisco.

Surgery isn’t typically offered unless other medical
treatments have failed or are not tolerated.



6.     
Spinal Fluid Shunt

In another type of surgical procedure, your doctor inserts
a long, thin tube (a shunt) into your brain or lower spine to
help drain away excess CSF. The shunt is led to your
abdomen or some other body cavity, where it dumps the
excess fluid.  Generally, a pressure valve is included in the
circuit to avoid excessive drainage when the patient is in an
upright position. Shunts can become clogged, and may
require additional surgeries to keep them working
properly.  Complications can include low-pressure
headaches and infections.



7.     
Lose Weight

As we saw above, obesity is a large risk factor in
developing intercranial hypertension.

So,  it makes sens
e then that losing weight can alleviate
symptoms of intercranial hypertension. According to a May
2014 report at McGill University, as little as a 5-10% loss in
weight yields a reduction in intracranial pressure, with
accompanying reduction of papilledema, and a 1998 study
at the Beth Israel Medical Center in New York  found that
weight loss improved visual field dysfunction, in addition to
papilledema reduction, in patients with IIH.


A 2004 study at UC San Francisco found that in obese
people, bariatric surgery (and especially gastric bypass
surgery) can lead to resolution of the condition in 95% of
cases.







































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