[New therapies for intracranial hypertension].
OBJECTIVE
The main concepts involved in the therapeutic management of intracranial hypertension are revisited, including pathophysiology, monitoring, the traditional approach, and also the presentation of recently proposed therapies.


METHODS
The main medical literature data bases (especially Medline and Lilacs) were searched for articles published in the last 10 years, and traditional text books and dissertations focusing the subject were consulted.


RESULTS
Intracranial hypertension may be associated with several cerebral neurologic lesions from traumatic, infectious or metabolic origin, and in severe cases may represent an important factor for morbidity and mortality. Increases in intracranial pressure interfere with cerebral blood flow; in order to maintain an adequate cerebral perfusion pressure, it is necessary to both reduce and control intracranial hypertension and combat low blood pressure from the very beginning of treatment. Adequate monitoring is essential, and the main points addressed in conventional management include elevation of the head of bed to 30 degrees C, central positioning of the head, optimization of hypocapnia, perfect metabolic and hydro-electrolyte balance, sedation, anti-convulsive therapy, liquor drainage, and the use of barbiturics, mannitol and furosemide. New therapies currently under investigation include the use of dexanabinol, hypertonic saline solutions, moderate hypothermia, decompressive craniectomy, optimization of cerebral perfusion pressure, and reduction in cerebral microvasculature pressure (Lund therapy).


CONCLUSIONS
The use of new therapies to effectively control intracranial hypertension, especially in cases that are refractory to the usual treatment, represent a promising scenario in the management of this problem.
Barbosa
Arnaldo Prata
AP
Departamento de Pediatria, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil. arnaldoprata@ufrj.br
Cabral
Sérgio Augusto
SA
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019586:Intracranial Hypertension / Q000209:etiology / Q000628:therapy*; D008991:Monitoring, Physiologic