Raised Intracranial

Pressure
and brain tumors
Dr Muna Mohamed
Causes of Raised intracranial
pressure
• mass lesions,
• cerebral oedema
• obstruction to CSF circulation causing
hydrocephalus,
• impaired CSF absorption
• cerebral venous obstruction
• in adults, intracranial pressure is less than 10–15 mmHg.

• The speed of pressure increase influences presentation.

• If slow, compensatory mechanisms occur, including

alteration in the volume of fluid in CSF spaces and
venous sinuses, which minimize symptoms.

• If Rapid increase, does not permit these compensatory

mechanisms to occur, leading to early symptoms,
including sudden death.
Clinical Features
• 6th cranial nerve (unilateral or bilateral) is most
commonly affected, but the 3rd, 5th and 7th
nerves may also be involved.

• Sixth nerve palsies are thought to be due either

to stretching of the long slender nerve or to
compression against the petrous temporal bone
ridge.
Clinical Features
• Trans-tentorial herniation of the uncus may
compress the ipsilateral 3rd nerve and
usually involves the pupillary fibres first,
causing a dilated pupil
• False localising contralateral 3rd nerve
palsy may also occur, perhaps due to
extrinsic compression by the tentorial
margin.
Clinical Features
• Vomiting
• Coma
• bradycardia
• arterial hypertension are later features of
RIP.
Cushing triad of acute raised
intracranial pressure
• HTN
• Bradycardia (late finding)
• Irregular breathing
Management
• Primary management include:
• relieving the cause
• (e.g. surgical decompression of mass
lesion, steroids to reduce vasogenic
oedema or shunt procedure to relieve
hydrocephalus).
 Management
• Supportive treatment includes;
• Intensive care support.
• maintenance of fluid balance.
• blood pressure control.
• head elevation.
• use of diuretics such as mannitol to decrease
intracranial pressure.
Brain Tumors
Classification
• primary vs. metastatic
• benign: non-invasive, but can be
devastating due to expansion of mass in
fixed volume of skull (mass effect)
• malignant: implies rapid growth,
invasiveness, but rarely extracranial
metastasis
Types of intracranial tumors

 neuroepithelial tissue
- astrocytic tumors: astrocytoma, glioblastoma
- oligodendroglial tumors
- oligoastrocytic tumors
- neuronal and mixed neuronal-glial tumors: ganglion
cell tumors, cerebral neurocytomas/ neuroblastomas
- embryonal tumors: medulloblastoma,
neuroectodermal
- other: pineal, ependymal, and choroid plexus
tumors
Types of intracranial tumors
• meningeal: meningiomas*, mesenchymal,
hemangioblastomas
• cranial and paraspinal nerves: schwannoma, neurofibroma
• lymphomas and hematopoietic neoplasms
• germ cell: germinomas, teratomas
• pituitary adenomas*
• sellar region: craniopharyngiomas, spindle cell oncocytoma
• cysts: epidermoid/dermoid cysts, colloid cysts
• local extension: chordomas, glomus jugulare tumors
• metastatic tumors
Clinical Features

• The presentation is variable and its influenced by the rate

of growth.

• Headache, nausea secondary to RIP.

• Headache, if present, is usually accompanied by focal

deficits or seizures

• slowly progressive focal neurological deficits

• location generalized or focal seizures are common.

Clinical Features

• The size of the primary tumor is of far less

prognostic significance than its location
within the brain.

• Tumors within the brainstem will result in

early neurological deficits, while those in
the frontal region may be quite large before
symptoms occur.
Investigations
• Diagnosis is by neuroimaging (CT scan, MRI)

• pathological grading following biopsy or resection

where this is possible.

• The more malignant tumors are more likely to

demonstrate contrast enhancement on imaging.

• If the tumor appears to be metastatic, further

investigation to find the primary will be required.
Treatment
• conservative: serial Hx, Px, imaging for slow
growing/benign lesions
• medical: corticosteroids to reduce cytotoxic
cerebral edema
• surgical: total or partial excision (decompressive,
palliative)
• shunt if hydrocephalus.
• Radiotherapy
• chemotherapy