神经外科学课件Increased ICP颅内压增高颅脑损伤讲稿.docx

1、神经外科学课件Increased ICP颅内压增高颅脑损伤讲稿教案及讲稿（教案）课程名称神经外科学年级2013级授课专业五年制教 师夏海坚职称副教授授课方式大课 示教学时6题目章节1、Increased Intracranial Pressure；2、颅内压增高；3、颅脑外伤教材名称1、医学英文原版改编双语教材外科学；2、外科学作者1、Lawrence W. Way Gerard M. Doherty；2、吴在德，吴肇汉出 版 社1、科学出版社；2、人民卫生出版社版次1、第1版；2、第8版教学目的要求1、 Pathology and Physiology of Increased Intrac

2、ranial Pressure 2、 Manifestations and Managements of Increased Intracranial Pressure3、颅内压增高的诊断4、颅内压增高的治疗原则5、脑损伤的受伤机制6、原发性脑损伤和继发性脑损伤的发病原理及临床表现教学难点1、Regulation of Intracranial Pressure2、脑疝的发生机制3、颅脑损伤的受伤机制教学重点1、Manifestations of Increased Intracranial Pressure2、脑疝的临床表现3、原发性脑损伤和继发性脑损伤的发病原理及临床表现外语要求Engli

3、sh教学方法手段1、Multimedia (Powerpoint) Teaching2、Lecture and Discussion in the Class3、利用多媒体图片及幻灯紧密结合临床实际，提问式讲解教材并举例说明参考资料1、 王忠诚主编王忠诚神经外科学第一版2、Mark S. Greenberg, M.D. Handybook of Neurosurgery, the Fourth Edition.教研室意见准备充分，内容详实，时间安排合理，教学方法丰富，经过教研室内集体备课及试讲，达到为本科生上大课要求。 教学组长： 教研室主任： 年 月 日 教学内容辅助手段时间分配Increa

4、sed Intracranial PressureOutline:A.Attention-Getting PointsQuestion:“Why shall we have to learn increased intracranial pressure?” Definition: Increased intracranial pressure is the pressure inside the cranial vault, created by the total volume of the intracranial contents and exert on cranial wall.B

5、. Main Part 1. Anatomy and definition of ICP 2. Definition of increased intracranial pressure 3. Pathogenesis (Causes) of increased ICP 4. Clinic symptoms and signs of increased ICP 5. Diagnosis of increased ICPC. ConclusionIncreased Intracranial PressureHollow, everyone. MayI have your attention, p

6、lease!Welcome to neurosurgical class! I know all of you have studied in this university for many years,and most of you will be doctors in the near future. But maybe it is your first time to contact with neurosurgery, and today I am very glad to stand here and share some basic neurosurgical knowledge

7、 with you, I hope it will be helpful.Speaking of neurosurgery, first, we will come to the fundamental part of neurosurgery- (that is) Increased Intracranial Pressure. What is Increased Intracranial Pressure? From the word, intracranial pressure, intra- means in, -cranial refers to head, so Intracran

8、ial Pressure means the pressure in head, we also call it ICP; and therefore, Increased Intracranial Pressure means the pressure in head is increased. We also call it raised ICP or Intracranial hypertension.Maybe you are wondering: the diseases of neurosurgery mean brain trauma, tumor, infectious and

9、 vascular diseases, et al. Why should we begin with Increased Intracranial Pressure? To answer this question, at the beginning we will review related anatomy of cranium and brain and finally, I think, you will get the answer by yourselves!1. Anatomy and Definition of Intracranial PressureAs we know,

10、 the cranium can be thought of a hollow, rigid sphere with constant volume, just like a closed container with poor distensibility. There is one large vent, the foramen magnum, and a number of smaller foramina for cranial nerves and blood vessels. There are 3 major components of cranium: they are bra

11、in, cerebrospinal fluid (CSF), and blood. All these components are essentially noncompressible. So we have an impression: the cranium is a closed container which can not extend easily, and the 3 major components can not be compressed very easily.As for the three components, I will introduce them one

12、 by one:Brain tissue: brain is made of bilateral hemispheres, brain stem and cerebellum. Cerebral hemisphere includes frontal, parietal, occipital, temporal and insular lobe.CSF: This is a picture of the brain. In the brain, there are fourventricles; ventricles are just like the drainage system of t

13、he brain. The shape of the ventricles is irregular, and ventricles are full of CSF.From these aspects. We can see there are four ventricles in the brain. The two lateral ventricles are on the top, then the third one in the middle, and the forth ventricle is at the bottom.The ventriclesare connected

14、with each other.However, how does CSF produce and circulate? CSF is secreted by choroid plexus in the ventricles.The choroid plexus is made entirely of vessels, and so we can understand CSF is from the blood vessel system, that is, CSF is from the circulatory system.CSF is mostly secreted from choro

15、id plexus in the two lateral ventricles, then goes down to the third ventricle and finally the fourth ventricle.After that, CSF will flow out of the ventricular system and comesto the subarachnoid spaces.Some CSF flows firstly to the spinal subarachnoid spaces and then to the cerebral subarachnoid s

16、paces,some CSF flows directly to the cerebral subarachnoid spaces which are on the surface of the brain. In the end, all CSF will be absorbed into the superior sagittal sinus by the arachnoid granulations which lay both sides of venous sinuses. This is a coronal scan of superior sagittal sinus. We c

17、an findarachnoid granulation, here and there.Because superior sagittal sinus belongs to the circulatory system(belongs to the blood vessel system). So at last CSF flows back into the blood vessels system. For an adult, everyday, about 500ml CSF is secreted and then absorbed by arachnoid granulations

18、 to keep a homeostasis.(keep a balance )In general, there are 3 major components in the cranium-brain, blood, and CSF. Brain is the major part, blood vessels system is within the brain. CSF is secreted by the brain, circulating in the ventricular system and subarachnoid spaces.2.Definition of Increa

19、sed Intracranial PressureNow, we have a general idea of therelationships among brain, cerebral blood, CSF, and the cranium, Which is easier for us to understand the definition of Increased Intracranial Pressure.At first, let us to see: what is ICP?Definition: Intracranial pressure is the pressure in

20、side the cranial vault, created by the total volume of the intracranial contents and exert on the cranial wall.Normal ICP has a value between 0.7 kPa (kilopascal) to 2.0 kPa for adults and 0.5 kPa to 1.0 kPa for children. ICP fluctuates because of intracranial arterial pulsations which affected by c

21、ardiac andrespiratory cycles.When ICP is persistently higher than 200mmH2O (15mmHg, 2kPa), we call it increased ICP, or intracranial hypertension. This is the definition of increased ICP. But be cautious! Increased ICP is not temporary; the higher ICP usually lasts for a long period of time until a

22、proper treatment is given.How to measure ICP?There are two methods can help us to measure ICP.Lumbar puncture is the first one. Its quite easy to perform and the most commonly used method.But this method is indirect. Normally, spinal subarachnoid spaces can communicate with cerebral subarachnoid spa

23、ces. When patient lying on his side, the pressure in the spinal subarachnoid spaces is equal to the pressure in the cerebral subarachnoid spaces. When we take spinal tap (lumbar puncture), the pressure of CSF can represent ICP. However, when there is a faultof communication from intracranial space t

24、o spinal canal, the pressure of CSF cannt represent ICP. In addition, lumbar puncture has a danger of acute brain herniation, so we should take it seriously.The 2nd way to measure ICP is ICP monitoring. In this method, we put the pressure monitoring probe like this into the brain, or within the vent

25、ricle, or in the subdural space or between dura and skull, to measure ICP directly. However, it is a traumatic examination.3. Pathogenesis(Causes) of Increased ICPThe causes of increased ICP are mainly: A. increased volume of normal intracranial contents. B. a space occupying lesion. C. congenital m

26、alformation.D. other diseases.A.The increase in volume of normal intracranial contents maybe due to: 、the increase in volume of brain including -cerebral edema and -benign intracranial hypertention. 、 The increase in volume of CSF-like hydrocephlus. 、The increase in volume of blood-like vasodilatati

27、on due to hypercapnia.B. Space occupying lesion including: intracranial hematoma, brain abscess, brain tumor and so on. This is a picture of the brain with a space occupying lesion, from it we can see: the volume of the hemisphere with tumor is obviously more than the opposite hemisphere, for here i

28、s a tumor; the increased ICP forced the brain shift from the high ICP area to the lower ICP area.This is a CT scan of intracranial hematoma, we can easily see that this hematoma here compressed the brain immensely.The midline structure shiftto theopposite side.C. Congenital malformation. Craniosteno

29、sis.The congenital malformations usually occur in children. From these pictures, we can see, with the development of the brain, the childs cranium have not developed correspondingly, compared with the brain, the cranium is small, and increased ICP occurs.D. Other diseases. Like this kind of fracture

30、, the cranium got smaller than normal, and the brain is almost incompressible, as a result, increased ICP may occur.4. Clinical Symptoms and Signs of Increased Intracranial pressure.Although the causes of increased intracranial pressure are different, some of the clinical manifestationsare the same,

31、 including:A. Headache The headache associated with increased intracranial pressure is usuallyworse on waking in the morning and is relieved by vomiting. ICP increases during sleep probably because of the disturbance of venous return due to lying down.The cause of the headache in increased ICP is pr

32、obably the traction on the blood vessels, and compression of the dura mater because they are pain-sensitivestructure.B. Nausea and vomiting. This is a very popular symptoms, it almost happened in every patient with increased ICP.C. Drowsiness. It is the most important clinical feature of increased ICP. It is the portent of rapid neurological deterioration and must be brushed asid