Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-23T03:40:59.267Z Has data issue: false hasContentIssue false

Chapter 16 - Increased Intracranial Pressure and Herniation Syndromes

from Section 3 - Specific Neurological Disorders in Emergency Medicine

Published online by Cambridge University Press:  10 January 2024

By
Diana J. Jho ,
Brian Rempe ,
James Burgess  and
Alexander K. Yu
Edited by
Thomas P. Campbell  and
Kevin M. Kelly
Thomas P. Campbell
Affiliation:
Allegheny Health Network, Pittsburgh
Kevin M. Kelly
Affiliation:
Allegheny Health Network, Pittsburgh
Get access

Summary

The cranial vault in an adult is an enclosed space encased by the rigid skull. The Monro–Kellie doctrine proposed in the early nineteenth century states that the volume inside the cranium is fixed and normally filled with the brain, cerebral spinal fluid, and blood in a state of equilibrium. An increase in the volume of one of these constituents must be compensated by a decrease in another. Intracranial pressure (ICP) is the pressure inside the skull due to the volume within the cranium. Elevated ICP can be severely debilitating and even life-threatening. It is very important to quickly identify signs and symptoms of elevated ICP, diagnose the pathology, and promptly initiate treatment in the emergency setting to prevent irreparable brain damage, significant disability, or death.

Keywords

Cushing’s reflexcerebral autoregulationvasogenic edemacytotoxic edemainterstitial edemaosmotic edemasubfalcine herniationuncal herniationtranstentorial herniationcerebellar tonsillar herniation
Type
Chapter
Information
Handbook of Emergency Neurology , pp. 235 - 245
Publisher: Cambridge University Press
Print publication year: 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adelson, PD, Ragheb, J, Kanev, P, et al. Phase II clinical trial of moderate hypothermia after severe traumatic brain injury in children. Neurosurgery 2005;56(4):740–754.Google Scholar
Ashwal, S. Neurologic evaluation of the patient with acute bacterial meningitis. Neurol Clin 1995;13(3):549–577.Google Scholar
Bader, MK, Arbour, R, Palmer, S. Refractory increased intracranial pressure in severe traumatic brain injury: barbiturate coma and bispectral index monitoring. AACN Clin Issues 2005;16(4):526–541.Google Scholar
Brain Trauma Foundation, American Association of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care. Hyperventilation. J Neurotrauma 2000;17(6–7):513–520.CrossRefGoogle Scholar
Clifton, GL, Miller, ER, Choi, SC, et al. Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med 2001;344(8):556–563.CrossRefGoogle ScholarPubMed
Clifton, GL, Valadka, A, Zygun, D, et al. Very early hypothermia induction in patients with severe brain injury (the National Acute Brain Injury Study: Hypothermia II): a randomised trial. Lancet Neurol 2011;10(2):131–139.CrossRefGoogle Scholar
Cushing, H. Concerning a definite regulatory mechanism of the vaso-motor centre which controls blood pressure during cerebral compression. John Hopkins Hosp Bull 1901;12:290–292.Google Scholar
De Simone, R, Ranieri, A, Montella, S, Bilo, L, Cautiero, F. The role of dural sinus stenosis in idiopathic intracranial hypertension pathogenesis: the self-limiting venous collapse feedback-loop model. Panminerva Med 2014;56(3):201–209.Google Scholar
Diringer, MN, Videen, TO, Yundt, K, et al. Regional cerebrovascular and metabolic effects of hyperventilation after severe traumatic brain injury. J Neurosurg 2002;96(1):103–108.CrossRefGoogle ScholarPubMed
Doczi, T. Volume regulation of the brain tissue: a survey. Acta Neurochir (Wien) 1993;121:1–8.CrossRefGoogle ScholarPubMed
Dorfman, JD, Burns, JD, Green, DM, DeFusco, C, Agarwal, S. Decompressive laparotomy for refractory intracranial hypertension after traumatic brain injury. Neurocrit Care 2011;15(3):516–518.Google Scholar
Edwards, P, Arango, M, Balica, L, et al. Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury: outcomes at 6 months. Lancet 2005;365(9475):1957–1959.Google Scholar
Eisenberg, HM, Frankowski, RF, Contant, CF, Marshall, LF, Walker, MD. High-dose barbiturate control of elevated intracranial pressure in patients with severe head injury. J Neurosurg 1988;69(1):15–23.Google Scholar
Etminan, M, Luo, H, Gustafson, P. Risk of intracranial hypertension with intrauterine levonorgestrel. Ther Adv Drug Saf 2015;6(3):110–113.CrossRefGoogle ScholarPubMed
Feigin, VL, Anderson, N, Rinkel, GJ, et al. Corticosteroids for aneurysmal subarachnoid haemorrhage and primary intracerebral haemorrhage. Cochrane Database Syst Rev 2005;20(3):CD004583.Google Scholar
Feldman, Z, Kanter, MJ, Robertson, CS, et al. Effect of head elevation on intracranial pressure, cerebral perfusion pressure, and cerebral blood flow in head-injured patients. J Neurosurg 1992;76(2):207–211.Google Scholar
Fodstad, H, Kelly, PJ, Buchfelder, M. History of the Cushing reflex. Neurosurgery 2006;59(5):1132–1137.Google Scholar
Gean, AD. Imaging of Head Trauma. Lippincott Williams & Wilkins, 1994.Google Scholar
Glimåker, M, Johansson, B, Halldorsdottir, H, et al. Neuro-intensive treatment targeting intracranial hypertension improves outcome in severe bacterial meningitis: an intervention–control study. PLoS One 2014;9(3):e91976.Google Scholar
Gobiet, W, Grote, W, Bock, WJ. The relation between intracranial pressure, mean arterial pressure and cerebral blood flow in patients with severe head injury. Acta Neurochir (Wien) 1975;32:13–24.CrossRefGoogle ScholarPubMed
Gudeman, SK, Miller, JD, Becker, DP. Failure of high-dose steroid therapy to influence intracranial pressure in patients with severe head injury. J Neurosurg 1979;51(3):301–306.Google Scholar
Hlatky, R, Valadka, A, Robertson, CS. Prediction of a response in ICP to induced hypertension using dynamic testing of cerebral pressure autoregulation. J Neurotrauma 2004;21:1152.Google Scholar
Jandolo, B, Casaglia, P, Morace, E. Cerebral pseudotumor and oral contraceptives (cerebral case). Riv Neurobiol 1978;24(1–2):106–108.Google Scholar
Joseph, DK, Dutton, RP, Aarabi, B, Scalea, TM. Decompressive laparotomy to treat intractable intracranial hypertension after traumatic brain injury. J Trauma 2004;57(4):687–693.CrossRefGoogle ScholarPubMed
Kaal, EC, Vecht, CJ. The management of brain edema in brain tumors. Curr Opin Oncol 2004;16(6):593–600.Google Scholar
Kellie, G. An account of the appearances observed in the dissection of two of the three individuals presumed to have perished in the storm of the 3rd, and whose bodies were discovered in the vicinity of Leith on the morning of the 4th November 1821 with some reflections on the pathology of the brain. Trans Med Chir Sci Edinburgh 1824;1:84–169.Google Scholar
Knapp, JM. Hyperosmolar therapy in the treatment of severe head injury in children: mannitol and hypertonic saline. AACN Clin Issues 2005;16(2):199–211.Google Scholar
Martinez, H, Arana, H, Gancedo, B, Larel, M, De Virgillis, M. A typical pseudotumor cerebri. Neuroophthalmology 2010;34:131–288.Google Scholar
McGillicuddy, JE. Cerebral protection: pathophysiology and treatment of increased cranial pressure. Chest 1985;87:85–93.Google Scholar
Mokri, B. The Monro–Kellie hypothesis: applications in CSF volume depletion. Neurology 2001;56(12):1746–1748.CrossRefGoogle ScholarPubMed
Monro, A. Observations on the Structure and Function of the Nervous System. Creech & Johnson, 1783.Google Scholar
Ng, I, Lim, J, Wong, HB. Effects of head posture on cerebral hemodynamics: its influences on intracranial pressure, cerebral perfusion pressure, and cerebral oxygenation. Neurosurgery 2004;54(3):593–597.CrossRefGoogle ScholarPubMed
Pickard, JD, Czosnyka, M. Management of raised intracranial pressure. J Neurol Neurosurg Psychiatry 1993;56:845–858.Google Scholar
Pickard, JD, Czosnyka, M. Raised intracranial pressure. In Hughes, RAC (ed.) Neurological Emergencies. BMG, 1994.Google Scholar
Rangel-Castillo, L, Gopinath, S, Robertson, CS. Management of intracranial hypertension. Neurol Clin 2008;26(2):521–541.Google Scholar
Rosner, MJ, Coley, IB. Cerebral perfusion pressure, intracranial pressure, and head elevation. J Neurosurg 1986;65:636–641.Google Scholar
Saul, TG, Ducker, TB, Salcman, M, Carro, E. Steroids in severe head injury: a prospective randomized clinical trial. J Neurosurg 1981;54(5):596–600.CrossRefGoogle ScholarPubMed
Schalén, W, Sonesson, B, Messeter, K, Nordström, G, Nordström, CH. Clinical outcome and cognitive impairment in patients with severe head injuries treated with barbiturate coma. Acta Neurochir (Wien) 1992;117(3–4):153–159.Google Scholar
Sheehan, JP. Hormone replacement treatment and benign intracranial hypertension. Br Med J (Clin Res Ed) 1982;284(6330):1675–1676.Google Scholar
Stocchetti, N, Maas, AI, Chieregato, A, van der Plas, AA. Hyperventilation in head injury: a review. Chest 2005;127(5):1812–1827.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×