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Intracranial Hypertension

  • Vânia Graner Silva Pinto
  • Alexandre Guimarães de Almeida Barros
  • Antonio Luis Eiras Falcão
Chapter

Abstract

Intracranial hypertension is arbitrarily defined as an intracranial pressure greater than 20–22 mmHg. The understanding of the mechanisms responsible for maintenance of intracranial pressure (ICP) in the normal range and how their disruption results in intracranial hypertension and its consequences, e.g., the herniation syndromes, is essential to adequate therapeutic management. The knowledge of early ICP-reduction directed interventions aiming to avoid secondary brain injury are crucial for improved outcomes in situations like a traumatic brain injury. In this setting, the individualized patient’s monitorization through advanced brain monitoring, e.g., real-time parenchymal pressure, and the implementation of the current therapies toward elevated ICP including patient positioning, adequate perfusion pressure, sedation, osmotherapy, and surgical decompression are necessary tools for the neurocritical care intensivist.

Keywords

Intracranial pressure Intracranial hypertension Cerebral herniation Cerebrovascular circulation 

Suggested Readings and References

  1. 1.
    Hawthorne C, Piper I. Monitoring of intracranial pressure in patients with traumatic brain injury. Front Neurol. 2014;5:121.  https://doi.org/10.3389/fneur.2014.00121.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Chesnut RM, Temkin N, Dikmen S, Rondina C, Videtta W, Petroni G, Lujan S, Alanis, Falcao A, la Fuenta G, Gonzalez L, Jibaja M, Lavarden A, Sandi F, Mérida R, Romero R, Pridgeon J, Barber J, Machamer J, Chaddock K. A Method of managing severe traumatic brain injury in the absence of intracranial pressure monitoring: the imaging and clinical examination protocol. J Neurotrauma. 2017. doi:  https://doi.org/10.1089/neu.2016.4472.
  3. 3.
    Plum F, Posner JB. The diagnosis of stupor and coma. 4th ed. Oxford: Oxford University Press; 2007. p. 96.Google Scholar
  4. 4.
    Schmidt B, Reinhard M, Lezaic V, et al. Autoregulation monitoring and outcome prediction in neurocritical care patients: Does one index fit all? J Clin Monit Comput. 2016;30:367–75.  https://doi.org/10.1007/s10877-015-9726-3.CrossRefPubMedGoogle Scholar
  5. 5.
    Lassen NA. Control of cerebral circulation in health and disease. Circ Res. 1974;34:749–60.  https://doi.org/10.1161/01.RES.34.6.749.CrossRefPubMedGoogle Scholar
  6. 6.
    Perez-Barcena J, Llompart-Pou JA, O’Phelan KH. Intracranial pressure monitoring and management of intracranial hypertension. Crit Care Clin. 2014;30:735–50..  https://doi.org/10.1016/j.ccc.2014.06.005CrossRefGoogle Scholar
  7. 7.
    Lazaridis C, Desantis SM, Smielewski P, Menon DK, Hutchinson P, Pickard JD, Czosnyka M. Patient-specific thresholds of intracranial pressure in severe traumatic brain injury. J Neurosurg. 2014;120:893–900.CrossRefGoogle Scholar
  8. 8.
    Eccher M, Suarez J. Cerebral edema and intracranial pressure. In: Critical care neurology and neurosurgery. Totowa: Humana Press; 2004. p. 49.Google Scholar
  9. 9.
    Strandgaard S, Olesen J, Skinhøj E, et al. Autoregulation of brain circulation in severe arterial hypertension. Br Med J. 1973;1:507–10.CrossRefGoogle Scholar
  10. 10.
    Teasdale G, Jennett B. Assessment of coma and impaired consciousness: A practical scale. Lancet. 1974;2:81–4.CrossRefGoogle Scholar
  11. 11.
    Carney N, Totten AM, O’Reilly C, et al. Guidelines for the management of severe traumatic brain injury, 4th Ed. Neurosurgery. 2017;80(1):6–15.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Vânia Graner Silva Pinto
    • 1
  • Alexandre Guimarães de Almeida Barros
    • 1
  • Antonio Luis Eiras Falcão
    • 1
  1. 1.Faculty of Medical SciencesState University of Campinas (UNICAMP)São PauloBrazil

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