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Management of raised intracranial pressure 

Management of raised intracranial pressure
Chapter:
Management of raised intracranial pressure
Author(s):

David K. Menon

DOI:
10.1093/med/9780199204854.003.1706_update_001

Update:

Indications for decompressive craniectomy in traumatic brain injury.

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date: 23 September 2020

Normal intracranial pressure (ICP) is between 5 and 15 mmHg in supine subjects. Intracranial hypertension (ICP >20 mmHg) is common in many central nervous system diseases and in fatal cases is often the immediate cause of death.

Aetiology and pathogenesis—increases in intracranial volume and hence—given the rigid skull—ICP may be the consequence of (1) brain oedema, (2) increased cerebral blood volume, (3) hydrocephalus, and (4) space-occupying lesions. Brain perfusion depends on the difference between mean arterial pressure and ICP, termed cerebral perfusion pressure (CPP). The normal brain autoregulates cerebral blood flow down to a lower limit of CPP of about 50 mmHg in healthy subjects, and perhaps 60 to 70 mmHg in disease. CPP reduction to below these values results in cerebral ischaemia....

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