Suport HIC Lp
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Transcript of Suport HIC Lp
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Sindromul de Hipertensiune Sindromul de Hipertensiune IntracranianaIntracraniana
(HIC)(HIC)
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Definitie – complex de semne si Definitie – complex de semne si simptome datorat dezechilibrului simptome datorat dezechilibrului intre continutul cranian si continator.intre continutul cranian si continator.
Cutia craniana - rigidaCutia craniana - rigida
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creiercreier vase sanguine
LCR +/- proces
expansiv
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Cutia cranianaCutia craniana• Rigida – exceptie la nou-nascut si sugar – Rigida – exceptie la nou-nascut si sugar –
distensiedistensie Normal : 1250 -1450 cm3Normal : 1250 -1450 cm3 Volumul scade doar in fracturile cu Volumul scade doar in fracturile cu
infundareinfundare
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LCRLCR Secretie 500 ml / zi Secretie 500 ml / zi 15o ml in intreg sistemul nervos15o ml in intreg sistemul nervos Produs – plexuri coroideProdus – plexuri coroide Absorbtie – vilozitati arahnoidieneAbsorbtie – vilozitati arahnoidiene
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Obstructie in circulatia LCR – hidrocefalie - HICObstructie in circulatia LCR – hidrocefalie - HIC
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Tesutul nervosTesutul nervos 90% din volumul craniului90% din volumul craniului
77% H77% H22O O Exces de apa = edem cerebralExces de apa = edem cerebral
Vasogenic Citotoxic InterstitialVasogenic Citotoxic Interstitial (tumori) (toxic) (hidrocefalie)(tumori) (toxic) (hidrocefalie)
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Vasele meningo-cerebraleVasele meningo-cerebrale
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Presiunea intracranianaPresiunea intracraniana
Normal - 0-12 mm Hg, 8-15 cm H2O
> 20 cm H2O !!! > 40 cm H2O – hernie cerebrala
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Etiopatogenie (1)Etiopatogenie (1) Malformatii congenitale – Malformatii congenitale –
craniostenoze, Arnold-Chiaricraniostenoze, Arnold-Chiari Tumori cerebrale – primitive, Tumori cerebrale – primitive,
metastazemetastaze TCC – hematoame, plagi cranio-TCC – hematoame, plagi cranio-
cerebralecerebrale Parazitoze – chist hidatic, cisticercozaParazitoze – chist hidatic, cisticercoza
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Etiopatogenie (2)Etiopatogenie (2) Patologie vasculara – hematoame Patologie vasculara – hematoame
primareprimare Boli inflamatorii/infectioase – abcese, Boli inflamatorii/infectioase – abcese,
tuberculomul cerebral, goma luetica, tuberculomul cerebral, goma luetica, SIDASIDA
Alte cauze – intoxicatii, alergiiAlte cauze – intoxicatii, alergii
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Tablou clinic (1)Tablou clinic (1)
Cefalee Cefalee simptom constantsimptom constant Agravata dimineataAgravata dimineata Agravata de tuse, stranut, efortAgravata de tuse, stranut, efort Ameliorata de varsaturaAmeliorata de varsatura
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Tablou clinic (2)Tablou clinic (2)
Varsaturi – matinale (“à jeun”)Varsaturi – matinale (“à jeun”) Spontane, fara efortSpontane, fara efort Nu sunt precedate de greataNu sunt precedate de greata Nu au legatura cu alimentatiaNu au legatura cu alimentatia ““in jet”in jet” Calmeaza cefaleeaCalmeaza cefaleea
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Tablou clinic (3)Tablou clinic (3)
Edem papilar – cresterea presiunii in teaca Edem papilar – cresterea presiunii in teaca nv. optic.nv. optic.
Poate lipsi in 1/3 din cazuri cu HICPoate lipsi in 1/3 din cazuri cu HIC
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Tablou clinic (3) – semne accesoriiTablou clinic (3) – semne accesorii
Modificari psihiceModificari psihice Pareze de nv. oculomotoriPareze de nv. oculomotori Tulburari vestibulareTulburari vestibulare Crize comitialeCrize comitiale
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ParaclinicParaclinic Rx craniu – ISTORIE!!!!Rx craniu – ISTORIE!!!! CTCT IRMIRM Angiografie, angioIRM, angioCTAngiografie, angioIRM, angioCT EEG, echo.EEG, echo.
Fund de ochiFund de ochi
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ComplicatiiComplicatii Vasculare – ischemie cand presiunea Vasculare – ischemie cand presiunea
intracraniana devine superioara intracraniana devine superioara presiunii din vasele cerebralepresiunii din vasele cerebrale
Mecanice – herniile cerebraleMecanice – herniile cerebrale
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SubfalciformaSubfalciformaTranstentoriala – hernia Transtentoriala – hernia
temporalatemporalaAmigdaliana in foramen Amigdaliana in foramen
magnummagnumCulmenului prin orificiul Culmenului prin orificiul
lui Pacchionilui Pacchioni
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Amigdaliana in foramen magnumAmigdaliana in foramen magnum
Culmenului prin orificiul lui PacchioniCulmenului prin orificiul lui Pacchioni
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Midraza – semn de hernie temporala
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Procese expansive intracranieneProcese expansive intracraniene
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ClinicaClinica Sindrom de HICSindrom de HIC Deficite neurologiceDeficite neurologice Crize comitialeCrize comitiale Sindroame de lobi – frontal, parietal, Sindroame de lobi – frontal, parietal,
temporal, occipitaltemporal, occipital
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Meningiom
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Adenom hipofizar
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Metastaze cerebrale
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Abces cerebral
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Chist hidatic
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Tratament Tratament ChirurgicalChirurgical
Radioterapie – conventionala, Radioterapie – conventionala, stereotactica, gamma-knifestereotactica, gamma-knife
ChimioterapieChimioterapie
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PrognosticPrognostic
In functie de tipul morfopatologic al In functie de tipul morfopatologic al leziuniileziunii
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