Direct consequences of intracranial pressure in infants
In babies and infants, the cranial bones are not yet firmly connected to each other. This has the advantage that the intracranial pressure caused by hydrocephalus is compensated by the fact that the cranial bones stretch apart. The circumference of the head increases, the fontanel is stretched and, depending on the severity of the pressure, curved outwards. The pressure on the brain tissue is not yet so massive.
Once the skull sutures and the fontanel are tightly closed, compensation is impossible due to the increasing circumference of the head. Consequently, the pressure inside the skull increases faster. The enlargement of the ventricles is not the real problem. Rather, it becomes dangerous when the pressure build-up in the ventricles displaces the brain tissue. Brain parts are shifted and vital areas are impaired, brain tissue is irreparably damaged. When CSF pressure increases, it can affect the blood supply to the brain. This results in a reduction of the oxygen content and the blood sugar. Many of our vital functions such as heartbeat and breathing are controlled by the brain stem (a part of the brain that connects the spinal cord to the brain). Very high brain pressure can compress it so much that heartbeat and breathing stop. This leads to cardiovascular disturbances and respiratory arrest.
If the increased or too low pressure in the brain is not medically treated, it can end fatally!
Clinical signs of acute cerebral pressure elevation:
- nausea/vomiting in a gush, often also on an empty stomach
- headaches; initially recumbent and spreading throughout the day, later permanent
- dysfunctions of vision, a so-called congestion papilla (swelling of the optic nerve)
- dysfunction of consciousness up to unconsciousness
- high blood pressure and thereby low heart rate (Cushing’s reflex)
- sudden strabismus, malpositioning of the eyes
- noise sensitivity, light aversion
- Respiratory failure
- neck stiffness
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