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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The major changes in clinical condition during and after encephalography may be explained by intracranial pressure variations. If neither intracranial hypertension nor CSF dynamic perturbations exist, minimal complications may be predicted, but in intracranial hypertension immediate deterioration may occur. Despite an apparently good level of tolerance, complications may develop if the compensation phenomena cannot occur: normal pressure hydrocephalus, craniosynostosis. In the cases with good clinical tolerance, minimal changes occur when air injection is administered at a slow rate and with a small volume.
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PMID:[Effect of fractionated pneumoencephalography on intracranial pressure]. 20 16

In 6 cases of oxycephaly, isotope (RIHSA) cisternography showed an altered CSF circulation with ventricular reflux or cisternal block and accumulation of the contrast at lumbosacral level. These changes express increased absorption of the CSF by the spinal arachnoid villi to compensate for reduced or nonexistent absorption by the subarachnoid villi of the vault, obstructed by chronic intracranial hypertension secondary to craniosynostosis. The possible clinical implications are outlined.
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PMID:Contribution to the study of craniostenosis: disturbance of the cerebrospinal fluid flow in oxycephaly. 50 Mar 83

Routine CT scanning in 221 patients with craniosynostosis revealed ventricular dilation in 40. In 5 hydrocephalus was obviously unrelated to the craniostenosis. The remaining 35 cases were associated almost exclusively with syndromic craniosynostosis. Ventricular dilation was mild in 22, moderate in 9, and marked in 4 patients. Clinical and radiological findings strongly suggest that three different mechanisms are involved in the pathogenesis of hydrocephalus: primary cerebral maldevelopment, brain atrophy, and CSF outflow obstruction. In the diagnosis of hydrostatic hydrocephalus with craniosynostosis, head circumference is no indicator of progressive hydrocephalus, and intracranial hypertension may be due either to CSF accumulation or to craniostenosis. The present study indicates that shunt treatment prior to correction of synostosis should be restricted to a few cases of rapidly progressing hydrocephalus. Secondary shunting of hydrocephalus may be considered if intracranial pressure remains high despite adequate cranial decompression. Shunting is not an appropriate treatment for craniostenosis--even in cases of concurrent ventricular dilation.
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PMID:Hydrocephalus in craniosynostosis. 324 97

Intracranial pressure changes occurring in patients with craniostenosis were studied by continuous monitoring of intracranial pressure in 20 children. Although clinical or radiologic evidence of intracranial hypertension was present in only one patient, 13 (65%) had persistent or episodic raised intracranial pressure. Intracranial hypertension occurred with involvement of both single and multiple sutures and in four of six patients with hydrocephalus and craniostenosis. Recordings after surgical treatment in nine patients revealed that several months elapsed before intracranial pressure improved significantly or returned to normal, despite apparently adequate bony decompression. This study confirms that continuous monitoring of intracranial pressure adds significantly to clinical assessment in determining the need for, and the efficacy of, surgical treatment in craniostenosis.
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PMID:Intracranial pressure changes in craniostenosis. 670 71

The indications for surgical correction of craniosynostosis in which there is involvement of only one of the cranial vault sutures have traditionally been based upon the cosmetic merits of the deformity alone. Whilst it is now appreciated that intracranial hypertension is commonly associated with the more complex forms of craniosynostosis, this aspect has not previously been addressed in detail among cases of single-suture craniosynostosis. This retrospective study reports our experience of overnight subdural intracranial pressure monitoring in 74 children with premature closure of a single cranial suture. A single coronal suture was involved in 37 patients, the sagittal suture in 25 and the metopic suture in 12. Intracranial pressure was raised in 13 (17%), borderline in 28 (38%) and normal in 33 (45%). Elevated intracranial pressure was seen more commonly where a midline suture was involved (sagittal or metopic) than when a single coronal suture was fused. We conclude that intracranial hypertension occurs in a significant proportion of children with single-suture craniosynostosis and suggest that this factor should be borne in mind during the initial assessment of these children so as to enable timely intervention where required and appropriate counselling of parents.
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PMID:Intracranial pressure in single-suture craniosynostosis. 754 54

The case of a 16-month-old baby girl with craniosynostosis associated with venous sinus stenosis and sinus pericranii is reported. Monitoring of intracranial pressure indicated increased cerebrospinal fluid outflow resistance in addition to increased intracranial pressure. Despite intracranial hypertension, however, the pressure-buffering capacity, expressed as pressure-volume index, was remarkably elevated. A similar case has not been reported in the literature. The mechanism of pressure-volume index elevation and the management of this anomaly are discussed.
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PMID:Craniosynostosis in the presence of a sinus pericranii: case report. 808 99

Sixteen patients were treated with shunting of cerebrospinal fluid (CSF) from the cisterna magna for raised intracranial pressure (15 cases) or CSF leak (one case). There were 11 patients with benign intracranial hypertension, three with craniostenosis, one with chronic meningitis and one with a CSF leak. Cisternal shunting was effective in all cases and obviated the problems of low pressure and sciatica found with lumbar-peritoneal shunts. There were 11 revisions over a total of 31.5 shunt years (i.e. one per 2.9 shunt years). The role of cisternal shunting in neurosurgical practice is discussed.
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PMID:CSF shunting from the cisterna magna: a report of 16 cases. 843 44

Although the incidence of elevated intracranial pressure is increased in patients with the craniosynostosis syndromes, the significance of these findings and their impact on clinical practice remain unclear. The morbidity related to elevated intracranial pressure in patients with Apert and Pfeiffer syndromes was reviewed. Sixty-seven patients with Apert syndrome and 39 patients with Pfeiffer syndrome were identified. The morbidity in 5 of the 106 patients (4.7 percent) was felt to be directly related to persistently elevated intracranial pressure. These included 2 deaths, 1 due to brainstem herniation after an elective subcranial Le Fort III advancement and 1 following removal of a lumboperitoneal shunt during the surgical release of syndactyly. The remaining 3 complications included bilateral papilledema detected 3.5 years after cranial vault remodeling in 1 patient and venous hypertension with excessive bleeding detected during elevation of the bicoronal flap in 2 patients, resulting in delay of a planned Le Fort III advancement. Patients with the syndromal craniosynostoses are at risk for complications resulting from elevated intracranial pressure from infancy through adulthood despite surgical attempts to increase cranial capacity in infancy. Clinical guidelines are proposed by which these patients should be evaluated beyond infancy in a regular fashion so as to reduce morbidity from unrecognized elevations in intracranial pressure.
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PMID:Morbidity associated with increased intracranial pressure in Apert and Pfeiffer syndromes: the need for long-term evaluation. 855 11

Captopril renography (CRS) with 99mTc-DTPA and 99mTc-MAG3 was performed on a 21-year-old woman with renovascular hypertension due to right renal artery stenosis caused by fibromuscular dysplasia. In the affected kidney, the renogram pattern was substantially changed with 99mTc-DTPA and 99mTc-MAG3 following the administration of captopril, and the quantitated renal uptake indicating individual renal function was significantly decreased in 99mTc-DTPA and slightly decreased in 99mTc-MAG3. In the contralateral normal kidney, the renogram showed some minor changes with both radioagents, while the quantitated renal uptake was significantly decreased with 99mTc-DTPA and substantially increased with 99mTc-MAG3. The combined use of physiologically different renal agents 99mTc-DTPA and 99mTc-MAG3 is helpful in investigating hemodynamic and functional changes in the stenosed kidney as well as the normal kidney in RVH.
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PMID:Differences between 99mTc-DTPA and 99mTc-MAG3 captopril renographies in renovascular hypertension. 880 Apr 57

The late development of intracranial hypertension after an aesthetically successful cranial vault expansion has been noted anecdotally in children with syndromic synostosis. If untreated, this process can lead to neurological and visual deterioration; however, the frequency of this problem is uncertain. In an attempt to detect this process before the onset of irreversible impairment, the authors have since 1991 incorporated routine ophthalmological evaluations into the multidisciplinary follow-up protocol for all patients with complex craniosynostosis. These examinations were performed at initial evaluation and at 6-month intervals thereafter. The present report focuses on the results in 22 consecutive infants with syndromic synostosis who underwent initial surgery between 1991 and 1994. All but 4 children underwent initial cranial reconstruction at 6-18 months of age. Four patients had papilledema preoperatively which in each instance resolved postoperatively. During the follow-up period, 8 children manifested evidence of late intracranial hypertension at a median of 16.5 months after initial operation(s): 4 developed asymptomatic papilledema, 1 had progressive proptosis, and 3 had other subtle clinical signs of increased intracranial pressure (ICP). Further evaluation disclosed a Chiari 1 malformation in 2 children; 4 had a 'beaten copper' appearance on skull radiographs, and 4 underwent lumbar puncture, which in each case demonstrated an opening pressure above 20 cm H2O. Only 3 children exhibited symptoms from the ICP elevation. Six children with a head size < or = the 25th percentile underwent a repeat cranial expansion; after the cranial vault expansion, one child who initially had slit-like ventricles developed ventriculomegaly and, because of persistent papilledema, underwent insertion of ventriculoperitoneal (VP) shunt. Two other patients with a head circumference above the 50th percentile and the development of moderate ventriculomegaly underwent VP shunt insertion alone. All children have had complete resolution of papilledema as well as other symptoms and signs of increased ICP without evidence of optic atrophy or neurological sequelae. This study indicates that the incidence of delayed, asymptomatic increases in ICP among children with complex craniosynostosis is higher than previously estimated. The pathophysiologic bases for this process are discussed. Because the detection of this problem at a presymptomatic stage should optimize the likelihood of a good functional outcome, we strongly recommend close ophthalmological and clinical follow-up as a part of the comprehensive care of all young children with complex craniosynostosis, even after a cosmetically successful cranial expansion.
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PMID:Incidence of increased intracranial pressure after early surgical treatment of syndromic craniosynostosis. 887 62


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