From the Guidelines
Intracranial hypertension is primarily caused by factors such as traumatic brain injury, space-occupying lesions, brain edema, cerebrospinal fluid circulation problems, increased cerebral blood volume, and systemic conditions affecting the brain, as supported by recent studies 1. The causes of intracranial hypertension can be broadly categorized into several key areas, including:
- Space-occupying lesions such as brain tumors, hematomas, and abscesses that directly increase volume within the rigid cranial vault
- Brain edema from trauma, stroke, or inflammation that can also increase tissue volume and pressure
- Cerebrospinal fluid (CSF) circulation problems, including hydrocephalus from obstruction or decreased absorption, which contribute significantly to increased pressure
- Increased cerebral blood volume from vascular disorders like venous sinus thrombosis or arteriovenous malformations that raises pressure
- Systemic conditions affecting the brain, including hypertensive encephalopathy, hepatic encephalopathy, and certain endocrine disorders
- Medications like tetracyclines, vitamin A derivatives, and corticosteroid withdrawal that can induce intracranial hypertension
- Idiopathic intracranial hypertension, which occurs primarily in young, overweight women without an identifiable cause
- Metabolic disturbances such as hypercapnia that cause cerebral vasodilation and increased pressure Understanding these causes is crucial for proper diagnosis and management, as treatment depends on addressing the underlying cause while managing symptoms and preventing complications like vision loss or brain herniation, as highlighted in studies 1. Key factors to consider in the management of intracranial hypertension include the need for monitoring and treatment of elevated ICP, the use of devices such as ventricular catheters or parenchymal catheters for ICP measurement and CSF drainage, and the importance of maintaining a cerebral perfusion pressure (CPP) of 50–70 mmHg depending on the status of cerebral autoregulation, as discussed in 1. In clinical practice, the decision to monitor and treat elevated ICP should be based on individual patient needs and the presence of clinical evidence of increased ICP, with careful consideration of the risks and benefits of ICP monitoring and treatment, as noted in 1.
From the FDA Drug Label
In patients with preexisting compromise of the blood brain barrier, the risk of increasing cerebral edema (general and focal) associated with repeated or continued use of 20% Mannitol Injection USP must be individually weighed against the expected benefits. A rebound increase of intracranial pressure may occur several hours after the infusion Patients with a compromised blood brain barrier are at increased risk.
The causes of intracranial hypertension include:
- Compromised blood brain barrier
- Rebound increase of intracranial pressure after infusion of mannitol
- Cerebral edema (general and focal) associated with repeated or continued use of mannitol 2
From the Research
Causes of Intracranial Hypertension
- Traumatic brain injury 3, 4, 5, 6
- Stroke, including large artery acute ischemic stroke 4
- Intracranial hemorrhage 4
- Intracranial neoplasms 4
- Diffuse cerebral disorders such as meningitis, encephalitis, and acute hepatic failure 4
- Reye's syndrome 3
- Hepatic coma 3
- Hydrocephalus 3, 4
- Pneumatocephalus 3
- Hygroma 3
- Contusion 3
- Hematoma 3
Pathological Conditions Leading to Intracranial Hypertension
- Increased intracranial pressure (ICP) due to various causes can lead to damage of neurons and jeopardize cerebral perfusion 3
- Elevated ICP can be caused by an increase in the partial pressures of brain, blood, and cerebrospinal fluid (CSF) 3
- Normal intracranial pressure is below 10 mmHg, and values above 20 mmHg are considered elevated 3, 4