Intracranial Acid Injection: Catastrophic Effects and Emergency Management

Direct acid exposure to intracranial contents is a neurosurgical catastrophe.

Pathophysiology

• Liquefactive necrosis of brain parenchyma.
• Hemorrhage from vessel destruction.
• Vasogenic edema → ↑ ICP → herniation risk.
• Seizures from cortical irritation.
• Hydrocephalus from inflammatory CSF obstruction.
• Death in severe volumes/concentrations.

Acute Management

• ICP monitoring, hyperosmolar therapy, sedation.
• Surgical decompression if herniation imminent.
• Irrigation/neutralization (experimental, case-report level).
• Antiseizure prophylaxis.

Outcome correlates with volume, concentration, and location.