Hirndruck

A unique case

of multiple calvarial hemangiomas with one large symplastic hemangioma. Sagittal T1 MRI image showing empty Sella turcica (red arrow) (a) and distended optic nerve sheaths (Blue arrows) on coronal T2 (b)

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Frank-ter

Haar syndrome associated with sagittal craniosynostosis and raised intracranial pressure. A-D: Patient 1. A: Antero-posterior (AP) view showing facial features including hypertelorism. B: Lateral view showing brachycephaly and micrognathia. C: X-ray (XR) right radius/ulna showing broad appearance of the radius at the junction between the proximal and middle thirds. D: XR left hand showing crowding of the carpal bones, broad metacarpals, proximal and middle phalanges, and flexion at the MCP and PIP joints. E-G: Patient 2. E: AP view showing facial features including hypertelorism. F: Lateral view showing brachycephaly. G: 3D CT scan showing absence of the sagittal suture. H-J: Patient 3. H: AP view showing facial features including hypertelorism. I: Lateral view showing class III malocclusion and brachycephaly. J: 3D CT scan showing absence of the sagittal suture.

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The intracranial pressure (ICP) represents the pressure exerted by the essentially incompressible components (brain tissue and interstitial fluids, blood and CSF) contained within the rigid confines of the skull .

ICP has a normal pulsatile variation derived from the transient changes in blood volume associated with the cardiac and respiratory circles .

Under a dynamic equilibrium, the normal range of CSF pressure is between 5 and 15 mmHg (7.5-20 cm H2O) . In children, however, there are different upper tolerated limits, defined for age groups - in general the normal interval is considered to be 3 to 7 mmHg for young children and 1.5 to 6 mmHg for term infants .

The Monro-Kellie hypothesis explains the pressure-volume relationship that aims to keep this dynamic equilibrium among the essentially non-compressible components inside the skull .

Changes in ICP have been shown to depend on four variables:

CSF production rate
intracranial compliance
outflow resistance
intradural sinus pressure

Physiological elevations of intracranial pressure can occur briefly (e.g. due to coughing, head-down tilt, and neck vein compression). As they are equally distributed throughout the spinal axis and last for a short period of time, they do not cause neurological damage .

See also

Siehe auch:

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