How are hydrocephalus and increased intracranial pressure treated in patients with encephalitis?

Updated: Aug 07, 2018
  • Author: David S Howes, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

In patients with hydrocephalus and increased intracranial pressure (ICP), general measures include management of fever and pain, control of straining and coughing, and prevention of seizures and systemic hypotension.

In otherwise stable patients, elevating the head and monitoring neurologic status usually are sufficient. When more aggressive maneuvers are indicated, early use of diuresis (eg, furosemide 20 mg IV, mannitol 1 g/kg IV) may be helpful, provided that circulatory volume is protected. Dexamethasone 10 mg IV q6h helps in managing edema surrounding space-occupying lesions. Hyperventilation (arterial CO2 tension [PaCO2] 30 mm Hg) may cause a disproportional decrease in cerebral blood flow (CBF), but it is used to control increasing ICP on an emergency basis.

Intraventricular ICP monitoring is controversial. Some authorities believe that dangerous focal edema with a pressure gradient between the temporal lobe and the subtentorial space usually is not detected by the monitor and that this failure of detection can lead to a false sense of security. In fact, monitor placement may potentially aggravate a pressure gradient.


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