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[MUSIC].

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Okay.

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So, what we focused on in this unit has
been problems within the cranium.

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And they all have they all feedback into
intracranial pressure which is really key.

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An intracranial pressure is, is key
because of what we call mass effect.

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And what that means is, lets consider our
three compartments.

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We have.

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The left hemisphere, the right hemisphere.

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So telencephalic left, telencephalic
right, and then we have infratentorial.

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And infratentorial, this down here we have
the brain stem.

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Up here we're talking about the forebrain.

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Now if the pressure increases enough in
any one

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of these compartments, the, the effect is
that it will start to push out.

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So the mass effect is simply that this.

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This increase in mass has to go somewhere,
it's going to push in, in all directions.

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It pushes against the skull, no luck
there, the skull's not moving.

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And so if it's going to start, if it
builds up enough

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it will push across these barriers, across
these, the brain's bulkheads.

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And now it will effect.

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Whatever else it, it, impacts.

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And in this case, this would be a sub, a,

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a falcine herniation and this would be a
tentorial herniation.

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The, the mass effect, the impact of the
mass

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effect is, is an impact that all of these.

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Problems have share in common.

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So a stroke, which is in the parenchyma of
the brain and

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intracranial bleed, which is a bleed
somewhere

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between the skull and the

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the The, the brain, a traumatic brain
injury.

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This is happening, unfortunately, more and
more as

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we continue to fight wars with fancier
weapons.

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People get shrapnel that enters the, the
brain.

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People are in automobile accidents.

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All these types of things concussions,
head banging on the head,

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all these various traumatic and/or
penetrating injuries.

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In addition this increase in pressure does
not have to be due

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to a stroke, it could be due to a growth,
a brain tumor.

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And even if that brain tumor is not

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going to actually send a metastases off
somewhere else.

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and is therefore not malignant, it is very
dangerous and can be lethal.

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If it grows so big that it, it impairs
brain function by increasing intracranial.

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Pressure.

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And finally, there's something that we

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haven't talked much about, which is
hydrocephalus.

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In hydrocephalus, let's just look for a
moment at the three compartments again.

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There is an inner structure to these three
compartments.

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Wher, which is the ventricle system and
the ventricles

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contain CSF and they feed the.

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The direction of flow for CSF is in this
direction.

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And then it goes and it fills this
subarachnoid space, but if

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this gets clogged up right here, which is
where it usually does get clogged up, then

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the, the CSF is being made but it can't
flow out.

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And now the.

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The brain is going to blow up from the,
from the inside.

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Because this happens most commonly in
babies.

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The brain, the skull of the baby is, is,
is

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more forgiving than the skull of a of an
adult.

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And so, it might take awhile.

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The, the baby might actually expand or
swell for awhile before this becomes

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symptomatic, because the pressure is so
big that the brain is no longer working.

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But in any case, eventually, hydrocephalus
will increase intracranial pressure.

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So, all of these things.

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Increase intercranial pressure.

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It is the major way in which all of these
things negatively

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impact brain function and lead to a great
deal of

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suffering and debilitation in people all
over the world.

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And from that not cheery note we'll
conclude this week and we'll go

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on to look at some things are working well
and I very much hope that for all of you

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that you don't encounter these in your
lives.

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[MUSIC]