두개강내 병소와 동반되는 급성 고혈압의 치료 : 이상적인 항고혈압 치료제의 선택을 중심으로 Focus on Selecting Ideal Antibypertensive Agents

박정율,이자규,이일옥,공명훈,송우혁,정흥섭,이기찬,이훈갑 고려대학교 의과대학 1997 고려대 의대 잡지 Vol.34 No.2

Patients with acute hypertension associated with intracranial pathology often require prompt reduction of elevated blood pressure. But the principal goal here is to ameliorate systemic hypertension while maintaining adequate cerebral perfusion pressure to provide required cerebral blood flow and thereby preventing secondary ischemic brain damage. Although many new antihypertensive agents are now available, the ideal agent along with optimal guidelines for blood pressure reduction still remain controversial in acute hypertensive patients with different types of intracranial pathologies. Object of this study was to first review briefly the cerebrovascular pathophysiology of hypertension in conjunction with management of these patients. Pertinent literature is searched, indexed, and referenced from MEDLINE for this purpose. From this information, along with clinical experiences, authors tried to provide some of basic guidelines for managing these patients in various clinical situations, focusing mainly on selecting ideal antihypertensive agents available at present time. From the present standpoint it is generally agreed that 1- or 1-adrenergic receptor antagonists provide arterial pressure reduction with little or no adverse effect on intracranial pressure within regulatory range. Although many promising calcium-channel blocking agents are now available, their use are often limited by their action to cause cerebral vasodilation and thus increased intracranial pressure. Angiotensin converting enzyme inhibitors can be used for moderate hypertension but have potential to further increase intracranial pressure in patients who already have intracranial hypertension. It has long been known that barbiturates can be adjuvant method in case of resistant or malignant hypertension with intractablly increased intracranial pressure since it decreases both the blood pressure and cerebral blood flow with reduction of oxygen metabolism. The proper management of acute hypertension in the patients with intracranial pathology should be based on sufficient understanding of the pathophysiology of hypertension and cerebral perfusion pressure. Ideal agents would be individually based on their ability to promptly and reliably ameliorate the hypertension and at the same time maintain adequate cerebral blood flow and intracranial pressure.

두개내 저혈압에서 두개내 고혈압으로의 진행을 안과적으로 진단한 증례

이지영(Jiyoung Lee),정연웅(Yeon Woong Chung) 대한검안학회 2021 Annals of optometry and contact lens Vol.20 No.3

목적: 양안 복시로 안과 내원한 환자에서 두개내 고혈압을 진단하고 그 선행 원인이 역설적으로 두개내 저혈압으로 인한 경막하혈종이었던 환자를 보고하고자 한다. 증례요약: 기저질환 고혈압이 있으며, 2개월 전 특발성 두개내 저혈압 진단 받은 29세 남자가 4일 전부터 시작된 양안 복시로 내원하였다. 양안 시력은 정상, 상대적 구심동공운동장애는 없었고, 시신경유두부종, 우측 제육뇌신경마비 소견, 좌안 시야검사에서 맹점확장 소견이 보여 두개내 고혈압을 생각할 수 있었다. 그러나 원인 감별을 위해 시행한 뇌컴퓨터단층촬영에서 최소 2-3주 지난 경막하혈종이 발견되어 두개내 저혈압의 합병증으로 발생한 경막하혈종이 순차적으로 두개내 고혈압을 일으켰을 가능성이 제기되었다. 결론: 두통을 동반한 두개내 고혈압으로 입원한 환자에서 뇌척수압이 감소되어 두개내 저혈압 발생으로 기존 두통이 지속된 증례는 있으나, 이와 반대로 두통이 지속된 두개내 저혈압 환자에서 두개내 고혈압으로 진행한 상황과 이를 안과적으로 처음 진단한 경우는 아직까지 보고된 바가 없어 본 증례를 보고하는 바이다. Purpose: To report a case of a 29-year-old binocular-diplopia patient diagnosed with intracranial hypertension, caused by a subdural hematoma due to intracranial hypotension. Case summary: A 29-year-old male hypertensive patient, diagnosed 2 months previously with idiopathic intracranial hypotension, presented to an ophthalmologist with a 4-day history of binocular diplopia. Visual acuity was 1.0/0.63 (1.0) without relative afferent pupillary defects. There was bilateral papilledema, right 6th cranial nerve palsy, and blind spot enlargement in visual field examinations, suggestive of intracranial hypertension. Computer tomography of the brain identified a 2- to 3-week-old subdural hematoma, a complication of intracranial hypotension, which may have led to intracranial hypertension. Conclusion: While persistent headaches in intracranial hypertension patients progress to intracranial hypotension due to lowered cerebrospinal fluid pressures, this is the first report of intracranial hypotension progressing to intracranial hypertension.

두개 내압 감시 장치를 이용한 두개강 내압 측정에 대한 임상적 연구

구환회,김윤 대한신경외과학회 1986 Journal of Korean neurosurgical society Vol.15 No.1

Continous monitoring of intracranial pressure can be one of the most important physical parameters in assesing patients who have or might develop intracranial hypertension. The author has measured an intracranial epidural pressure by use of a Fiberoptic pressure monitor on 20 cases among brain damaged patients and evaluated it's effect by an epidural pressure change and Glasgow coma scale change after craniectomy and hypertonic solution infusion. Intracranial pressure was compared with signs of increased ICP on brain computed tomography. Also, complications were evaluated. The results are as follows ; 1) Average intracranial pressure was significantly decreased 48㎝ H₂O during the first day after craniectomy. 2) Average intracranial pressure was significantly decreased 33㎝ H₂O after infusion of 10 % glycerol. 3) Improvement of the clinical states after craniectomy was not found in the cases above 20㎝H₂O in spite of decreasing intracranial pressure. 4) Sixteen of seventeen patients showing signs of increased intracranial pressure on brain computed tomography on admission developed elevated intracranial pressure. 5) The infection and intracranial hemorrhage were not found at the monitoring implement site three weeks after removing the intracranial pressure monitor.

두개강내 고혈압의 내과적 조절

박성식 대한마취통증의학회 2009 Anesthesia and pain medicine Vol.4 No.3

Normal intracranial pressure (ICP) is below 10−15 mmHg. It may increase as a result of traumatic brain injury, stroke, neoplasm or other pathologies. When ICP is pathologically elevated it needs to be lowered. Effective management of intracranial hypertension involves meticulous avoidance of factors that precipitate or aggravate intracranial hypertension. It is important to rule out space occupying lesion that should be surgically removed. Medical managements of intracranial hypertension include maintenance of proper oxygenation and cerebral perfusion pressure and osmotheraphy with either mannitol or hypertonic saline. For intracranial hypertension refractory to initial medical treatment, profound hyperventilation, barbiturate coma or hypothermia should be considered. Steroids are not indicated and maybe harmful in the treatment of intracranial hypertension caused by traumatic brain injury.

특발두개내압상승 환자에서 혈관 압박에 의한 부분눈돌림신경마비

이설원,황승배,신병수,서만욱,오선영 대한평형의학회 2017 Research in Vestibular Science Vol.16 No.3

Pupil-involving oculomotor nerve palsy (ONP) is frequently associated with compressive lesion such as intracranial aneurysm originating from the posterior communicating arteries. Vascular variant of posterior intracranial circulation is regarded as an uncommon cause and association between these vascular variants and intracranial hypertension has not been reported. We present an 18-year-old girl with pupil-involving ONP combined with idiopathic intracranial hypertension who revealed compression of oculomotor nerve by a vascular variant of superior cerebellar artery (SCA). This is a rare case of an ONP attributed to compressive effect from an aberrant SCA affected by intracranial hypertension.

The Monitoring of Brain Edema and Intracranial Hypertension

Mohammad I Hirzallah,H. Alex Choi 대한신경집중치료학회 2016 대한신경집중치료학회지 Vol.9 No.2

Preventing secondary brain injury after neurological insults is one of the primary goals of the neurocritical care unit. Our understanding of the roles of intracranial pressure (ICP) and cerebral edema in managing patients in the neurocritical care units is still evolving. Recent clinical trials examining the monitoring and treatment of elevated ICP have influenced the way we think about intracranial hypertension. Additionally, new methods of monitoring ICP, new physiologic surrogates derived from ICP measurements, and evolving technology to measure cerebral edema are currently being studied and tested for clinical efficacy. In this article, we will discuss both traditional and novel methods of monitoring ICP and cerebral edema.

Primary Spinal Cord Astrocytoma Presenting as Intracranial Hypertension: A Case Report

임성룡,이승주,임승철 대한척추신경외과학회 2012 Neurospine Vol.9 No.3

Increased intracranial pressure (IICP) is rarely seen in association with primary spinal tumors. We describe a 58-year-old man who was diagnosed with a primary spinal cord astrocytoma, who first presented with hypesthesia, followed by intracranial hypertension, papilledema and blurred vision. On first admission, he presented with hypesthesia but without paraparesis, headache or blurred vision. Spinal MRI showed a relatively well-enhanced solid mass with a cystic portion at the cervico-thoracic level, shown histologically to be a grade I pilocytic astrocytoma. After gross total resection of the tumor, the patient had no significant neurological changes. Nine months later, the patient was admitted with headache, blurred vision and paraparesis. An ophthalmologic examination showed papilledema and lumbar tapping revealed IICP. A spinal MRI showed recurrence of the tumor which was found to be a glioblastoma after reexplorative debulking surgery. After resection, his headaches and blurred vision improved, but his paraparesis did not. These findings show that a primary spinal cord astrocytoma may cause IICP. Increased intracranial pressure (IICP) is rarely seen in association with primary spinal tumors. We describe a 58-year-old man who was diagnosed with a primary spinal cord astrocytoma, who first presented with hypesthesia, followed by intracranial hypertension, papilledema and blurred vision. On first admission, he presented with hypesthesia but without paraparesis, headache or blurred vision. Spinal MRI showed a relatively well-enhanced solid mass with a cystic portion at the cervico-thoracic level, shown histologically to be a grade I pilocytic astrocytoma. After gross total resection of the tumor, the patient had no significant neurological changes. Nine months later, the patient was admitted with headache, blurred vision and paraparesis. An ophthalmologic examination showed papilledema and lumbar tapping revealed IICP. A spinal MRI showed recurrence of the tumor which was found to be a glioblastoma after reexplorative debulking surgery. After resection, his headaches and blurred vision improved, but his paraparesis did not. These findings show that a primary spinal cord astrocytoma may cause IICP.

Venous Sinus Thrombosis in the Hypoglossal Canal Mimics a Neurogenic Tumor in a Patient with Presumed Idiopathic Intracranial Hypertension: A Case Report

Kiok Jin,Ji Eun Park,Jeong Hyun Lee 대한영상의학회 2022 대한영상의학회지 Vol.83 No.5

Presumed idiopathic intracranial hypertension (IIH) is a disorder of elevated intracranial pressure with unknown etiology, and 10% of cases occur secondarily to cerebral venous sinus thrombosis (CVST). CVST may be underestimated when findings of IIH are missed in a normal-weight patient without risk factors of coagulopathy. Here, we present a case of CVST that mimics a neurogenic tumor in the hypoglossal canal in a normal-weight patient without risk factors of coagulopathy.

편측 동안신경마비로 발현된 연수막암종증과 두개내압상승

조민섭,박성파,서종근 대한신경과학회 2021 대한신경과학회지 Vol.39 No.4

Meningeal carcinomatosis is caused by cancer cells invading the meninges and can cause cranial nerve palsies or intracranial hypertension. Intracranial hypertension can present various symptoms such as headache, visual loss, diplopia and may rarely include unilateral cranial nerve palsy. We report a 57-year-old female with leptomeningeal carcinomatosis and intracranial hypertension who presented as unilateral oculomotor nerve palsy.

소아 가성뇌종양에 의한 양안 유두부종 및 시야장애 1예

최윤정,안영민,박성은,Yoon Jung Choy,MD,Young Min Ahn,MD,Sung Eun Park,MD 대한안과학회 2010 대한안과학회지 Vol.51 No.9

Purpose: To report a case of bilateral papilledema and visual field defect in pediatric idiopathic intracranial hypertension. Case summary: The 5-year-old female patient was admitted to the hospital, complaining of headache and vomiting of 3 weeks duration. After admission, she complained of diplopia. The uncorrected visual acuity was 0.3 in the right eye and 0.8 in the left. An alternative prism cover test showed approximately 35 PD esotropia, with a -2 abduction limitation of both eyes. Fundus examination showed bilateral papilledema and peripapillary retinal hemorrhages. No abnormality was found in the MRI and CT, symptoms of headache, vomiting, bilateral papilledema, and esotropia with normal neurologic examination. Therefore, she was diagnosed with pediatric idiopathic intracranial hypertension. In Humphrey visual field test, MD was -14.15 dB in right and -16.58 dB in the left eye. Also, the general sensitivity of visual field decreased. Acetazolamide (Diamox®) was given orally for 30 days. Forty-four days after the initial visit, peripapillary retinal hemorrhages and vessel tortuosity decreased. Furthermore, visual acuity improved to 1.0 in the right eye and 0.9 in the left. The esotropia reduced to 5 PD, and MD improved to -4.83 dB in the right eye and -5.24 dB in the left. J Korean Ophthalmol Soc 2010;51(9):1292-1297