Idiopathic Intracranial Hypertension

and bipolar attacks. Idiopathic intracranial hypertension may explain bipolar attacks. This attack of intercranial hypertension can happen to anyone, anytime and will definitely affect behaviour, mood, cognition, breathing and the other vital signs. There are no tests for this. Most of what we know about intracranial hypertension comes from open head injury patients and from experiments with animals. Monitoring intracranial pressure requires opening the skull and using invasive methods…..

This is a likely hypothesis explaining attacks of depression, depressed breathing, suddenly slowed mental function, high blood pressure [to maintain blood flow to the brain] and inhibition of motor activity. Increase in inter cranial pressure will cause a reflex increase in blood pressure. When these compensations begin to fail, then the Cushing response kicks in, with irregular respirations, difficulty maintaining high enough blood pressure to perfuse the brain and intermittent lower than normal heart rate (bradycardia) masked by physical agitation and sudden change to mania.

The changes to the patterns of physiological vital signs and behavior in the depressed and manic stages are significant and it is not surprising to observe that the voluntary muscles of the body used for breathing and for locomotor activity are involuntarily inhibited or excited, most likely to compensate for increasing intracranial pressure due to rising PCO2 in the blood.

This is the kind of hypothesis that would be investigated in a biological clinic for mental illnesses such as manic depressive insanity. The hypothesis would be based on physical findings, especially minute ventilation (;see previous blogposts) and the rest. ( again refer to past blogs). The abnormal mood, locomotor activity and altered mental status can easily be linked to abnormal and impaired ventilation, of the kind Dr Emile Kraepelin found in the last century. ( in thousands of patients in the bipolar stages of this syndrome) . Because of Kraepelin’s comments on depressed ventilation in depressed patients, we found Paula’s breathing rate ( discussed in previous blogposts…) to be further evidence of the urgent need to explore this hypothesis further.

We understand that psychiatry and psychology lack the scientific knowledge to scientifically explore this hypothesis.

We understand that a specialized biological clinic would investigate the link between ventilation – requiring the motor systems of the body, and the partial pressure of carbon dioxide which is produced by cellular metabolism and the requirement for the brain to contain the pressures inside the skull, especially if pressures become high enough to affect behavior. Oddly enough, it seems that in an ambulatory person, the changes to mental status and locomotor behavior may be detrimental to normal function in life AND be beneficial to managing hypercapnia and intracranial pressure, when the ventilators system is damaged and when it becomes overwhelmed.

We know from the case of my friend Paula, that when locomotor activity and mental status and blood pressure and heart function and rate and body temperature become normal, breathing rate remains broken.

And we only know this because we have measured her vital signs at rest, which anyone can easily do with minimal training.

A biological clinic for mental illness would understand that sympathetic activity ( BP, HR, Temperature) will return to normal when the crisis has passed, and with normal sympathetic activity will return the original baseline mental function.

Hence, by following vital signs and monitoring the return of normal mental function and behavior we can learn to give the correct supportive medical care and treatments even if ventilation (breathing) systems are irrevocably damaged.

To be clear, this is not a lung problem per se, it is a motor problem, a neurological problem, affecting key systems that usually effectively

In a biological clinic for manic depressive attacks, Jerry would have received care focusing on airway, breathing and circulation, and proper refeeding and rehydration, in order to restore normal ( for him ) intracranial pressure and PCO2 and thus normal baseline level mental status [ Jerry had excellent marks in his University Literature degree before he fell ill]. . And he would be monitored for life to avoid future episodes and he would be able to live a normal life as the University French Professor he always wished to be. We discussed Jerry’s illness in past blogs.

….to be continued…..


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