What are the treatments for increased intracranial pressure?

Increased intracranial pressure can occur in both infants and the elderly, but due to their physical constitution, the disease course is longer in the elderly and it is more difficult to treat. After suffering from this disease, headache is the most obvious symptom, but the degree of pain also varies, with it getting worse in the morning and evening and getting better during the day. Therefore, you should avoid bending over and lowering your head frequently.

(1) Glucocorticoids: They are extremely important and effective auxiliary drugs for the treatment of secondary cerebral edema caused by brain metastasis of malignant tumors. Commonly used drugs include dexamethasone, methylprednisolone, and prednisone. They can block the effects of tumor toxic metabolism on blood vessels. Their clinical efficacy appears quickly and can last for 6 to 48 hours, or even up to 3 to 7 days, and can relieve clinical symptoms in 60% to 80% of patients. The general starting dose is dexamethasone 15 mg/d (other glucocorticoids can be converted according to their efficacy). For those who do not respond to the general dosage, the dosage can be increased to 30 mg, 60 mg, or even 100 mg per day; the improvement of symptoms is better than the improvement of signs. It should be used with caution in patients with ulcers, diabetes, or bleeding diseases. Cimetidine (cimetidine), ranitidine, or omeprazole (Losec) may be added to prevent stress ulcers.

(2) Osmotic therapy: Use of osmotic diuretics to reduce the amount of extracellular fluid in the brain and systemic water. Commonly used drugs include mannitol, urea, sorbitol or glycerol, which must be injected intravenously or dripped rapidly into the vein. After this type of drug enters the blood vessels, the osmotic pressure gradient difference between the intravascular and extracellular spaces allows water to smoothly return to the blood vessels from the brain cell spaces through the blood-brain barrier and be excreted by the kidneys along with the osmotic diuretic. Intracranial pressure decreases as the water content in the interstitial spaces between brain cells decreases, improving cerebral blood flow. Generally, symptoms and signs can be improved within 15 to 30 minutes after medication, and the strongest effect is around 2 hours. If no other treatment is given, intracranial pressure may not only increase again after 4 to 6 hours, but may also "rebound", with intracranial pressure being higher than before treatment. Therefore, the drug should be given once every 6, 8 or 12 hours depending on the condition of the patient: 1 to 2 g/kg for mannitol or sorbitol, 0.5 to 1 g/kg for urea, and 1 g/kg for glycerol. Even if treatment is insisted on, the condition may worsen again within a few weeks due to the increase in brain metastases. During osmotic therapy, fluid intake should be appropriately limited, and furosemide may be added to complement osmotic diuretics.

(3) Emergency or first aid treatment of brain metastases: When patients suffer from acute or subacute functional impairment or neurological damage and develop symptoms or signs such as headache, nausea, vomiting, mental disturbances, epileptic seizures or changes in habits, it may be due to enlargement of brain metastases or bleeding, obstruction of cerebrospinal fluid return, cerebral edema or communicating hydrocephalus, increased intracranial pressure, electrolyte imbalance, liver and kidney damage, or central nervous system infection. The disease may develop suddenly or progress insidiously. Such cases require clinical emergency relief of symptoms while undergoing examination and treatment. Perform a neurological examination, brain CT or MRI examination, or other special examinations to determine the cause of the clinical symptoms and use medical and/or surgical means to correct the main cause as soon as possible. Nonspecific treatment is used immediately as needed.