brain, spinal cord, and nerve disorders
Brain Herniation
Treatment of Brain Herniation
Measures to help people breathe Treatment of the cause Measures to reduce the increased pressure within the skull Prompt treatment of brain herniation is crucial. If a person is rapidly becoming less alert and more difficult to arouse, immediate treatment is required, often before the cause can be diagnosed. Treatment is similar to Treatment . The cause of brain herniation is treated when possible. The first steps in treatment, sometimes done by emergency medical personnel, are to check the following and treat them if needed: Whether the airway is open Whether breathing is adequate Whether pulse, blood pressure, and heart rate are normal (to make sure blood is reaching the brain) People are treated first in an emergency department and then admitted to a hospital intensive care unit. In both places, nurses can monitor heart rate, blood pressure, temperature, and the oxygen level in the blood. Any abnormalities in these measurements are immediately corrected to prevent further damage to the brain. Oxygen is often given immediately, and a tube is inserted into a vein (intravenous line) so that drugs or sugar (glucose) can be given quickly. If people have a very high or low body temperature, measures are taken to cool ( Treatment ) or warm them ( If doctors suspect that the pressure within the skull is increased, a breathing tube is inserted through the mouth so that Mechanical Ventilation can be used to make sure that enough carbon dioxide is exhaled and to maintain adequate oxygen levels in the blood. Most people with brain herniation need a mechanical ventilator to breathe for them. Mechanical ventilation is also used to quickly decrease the increased pressure within the skull. The breathing tube is inserted through the mouth and into the windpipe (trachea)—called endotracheal intubation. Oxygen is delivered directly into the lungs through the tube. The tube also prevents people from inhaling stomach contents after vomiting. Before inserting the tube, doctors may spray the person's throat with a numbing spray or give the person a drug to prevent the muscles from contracting involuntarily (a paralytic drug). The tube is then attached to a mechanical ventilator. Mechanical ventilation can cause agitation, which can be treated with a sedative. If pressure within the skull (intracranial pressure) is increased, the following measures may be taken to lower it: The head of the bed may be elevated. Mechanical ventilation is used to make people breathe faster (called hyperventilation). Breathing faster removes carbon dioxide from the lungs and reduces the level of carbon dioxide in the blood. As a result, blood vessels in the undamaged part of the brain narrow, and less blood reaches the brain. This measure quickly but temporarily lowers pressure within the skull and temporarily stops herniation. The beneficial effect of hyperventilation lasts about 30 minutes. Doctors use this time to start treatments that can stop herniation, such as drugs and surgical procedures, which take more time. Diuretics or other drugs may be used to reduce fluids in the brain and rest of the body. Diuretics help eliminate excess fluid by causing the kidneys to excrete more sodium and water into urine. A sedative may be given to control excess involuntary muscle contractions or agitation caused by mechanical ventilation. These problems can increase pressure within the skull. Blood pressure is lowered if it is very high. Sometimes doctors insert a drain (shunt) in the ventricles of the brain to drain cerebrospinal fluid. Removing excess fluid can help lower pressure within the skull. If pressure is increased because of a brain tumor or abscess, corticosteroids, such asdexamethasone, may help reduce pressure. However, corticosteroids are not used when increased pressure is caused by certain other disorders, such as bleeding within the brain or a stroke, because corticosteroids may make these conditions worse. If other measures do not work, the following may be tried: When pressure within the skull is increased after a head injury or cardiac arrest, measures to lower body temperature may be tried. These measures may help some people who have had cardiac arrest. However, this measure is controversial. Pentobarbital(a barbiturate) may be used to reduce blood flow to the brain and brain activity. This treatment may improve the prognosis for some people. However, it is not beneficial for everyone, and it has side effects, such as low blood pressure and abnormal heart rhythms. The skull may be opened surgically (craniectomy), creating more room for the swollen brain and thus reducing pressure on the brain. This treatment can prevent death, but it may not improve a person's ability to recover function. 