Intracranial Hypertension

  • Romergryko G. Geocadin
  • Michael A. Williams
  • Daniel F. Hanley


Intracranial hypertension (ICH) is the elevation of the intracranial pressure (ICP). ICH has been directly linked to morbidity and mortality associated with various neurologic insults including head trauma, intracranial hemorrhage, ischemic infarction, tumors, and hydrocephalus. ICP monitoring remains an integral tool for evaluating the severity and progression of the pathologic process. The management of ICH should be guided by ICP monitoring with the goals of ensuring adequate cerebral perfusion and controlling ICP.


Intracranial Hypertension Cerebral Perfusion Pressure Severe Head Injury Cranial Vault Cerebral Herniation 
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  1. 1.
    Rasomoff H. Methods of simultaneous quantitative estimation of intracranial contents. J Appl Physiol 1953; 16: 395–6.Google Scholar
  2. 2.
    Rubin RC, Henderson ES, Ommaya AK, Walker MD, Rall DP. The production of cerebrospinal fluid in man and its modification by acetazolamide. J Neurosurg 1966; 25: 430–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Cutler RW, Page L, Galicich J, Watters GV. Formation and absorption of cerebrospinal fluid in man. Brain 1968; 91: 707–20.PubMedCrossRefGoogle Scholar
  4. 4.
    Borgesen SE, Gjerris F. Relationships between intracranial pressure, ventricular size, and resistance to CSF outflow. J Neurosurg 1987; 67: 535–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Weiss MH, Wertman N. Modulation of CSF production by alterations in cerebral perfusion pressure. Arch Neurol 1978; 35: 527–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Martins AN, Wiley JK, Myers PW. Dynamics of the cerebrospinal fluid and the spinal dura mater. J Neurol Neurosurg Psychiatry 1972; 35: 468–73.PubMedCrossRefGoogle Scholar
  7. 7.
    Cardoso ER, Rowan JO, Galbraith S. Analysis of the cerebrospinal fluid pulse wave in intracranial pressure. J Neurosurg 1983; 59: 817–21.PubMedCrossRefGoogle Scholar
  8. 8.
    Recommendations for intracranial pressure monitoring technology. Brain Trauma Foundation. J Neurotrauma 1996; 13: 685–92.CrossRefGoogle Scholar
  9. 9.
    Smith RW, Alksne JF. Infections complicating the use of external ventriculostomy. J Neurosurg 1976; 44: 567–70.PubMedCrossRefGoogle Scholar
  10. 10.
    Aucoin PJ, Kotilainen HR, Gantz NM, Davidson R, Kellogg P, Stone B. Intracranial pressure monitors. Epidemiologic study of risk factors and infections. Am J Med 1986; 80: 369–76.PubMedCrossRefGoogle Scholar
  11. 11.
    Mayhall CG, Archer NH, Lamb VA, Spadora AC, Haggett JW, Ward JD, Narayan RK. Ventriculostomy-related infections. A prospective epidemiologic study. N Engl J Med 1984; 310: 553–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Ohrstrom JK, Skou JK, Ejlertsen T, Kosteljanetz M. Infected ventriculostomy: bacteriology and treatment. Acta Neurochir (Wien) 1989; 100: 67–9.CrossRefGoogle Scholar
  13. 13.
    Paramore CG, Turner DA. Relative risks of ventriculostomy infection and morbidity. Acta Neurochir (Wien) 1994; 127: 79–84.CrossRefGoogle Scholar
  14. 14.
    Vries JK, Becker DP, Young HF. A subarachnoid screw for monitoring intracranial pressure. Technical note. J Neurosurg 1973; 39: 416–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Mendelow AD, Rowan JO, Murray L, Kerr AE. A clinical comparison of subdural screw pressure measurements with ventricular pressure. J Neurosurg 1983; 58: 45–50.PubMedCrossRefGoogle Scholar
  16. 16.
    Winn HR, Dacey RG, Jane JA. Intracranial subarachnoid pressure recording: experience with 650 patients. Surg Neurol 1977; 8: 41–7.PubMedGoogle Scholar
  17. 17.
    Crutchfield JS, Narayan RK, Robertson CS, Michael LH. Evaluation of a fiberoptic intracranial pressure monitor. J Neurosurg 1990; 72: 482–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Khan SH, Kureshi IU, Mulgrew T, Ho SY, Onyiuke HC. Comparison of percutaneous ventriculostomies and intraparenchymal monitor: a retrospective evaluation of 156 patients. Acta Neurochir (Wien) Suppl 1998; 71: 50–2.Google Scholar
  19. 19.
    Bekar A, Goren S, Korfali E, Aksoy K, Boyaci S. Complications of brain tissue pressure monitoring with a fiberoptic device. Neurosurg Rev 1998; 21: 254–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Indications for intracranial pressure monitoring. Brain Trauma Foundation. J Neurotrauma 1996; 13: 667–79.CrossRefGoogle Scholar
  21. 21.
    Lundberg N. Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Scand Suppl 1960; 149: 1–193.Google Scholar
  22. 22.
    Hayashi M, Handa Y, Kobayashi H, Kawano H, Ishii H, Hirose S. Plateau-wave phenomenon (I). Correlation between the appearance of plateau waves and CSF circulation in patients with intracranial hypertension. Brain 1991; 114: 2681–91.PubMedCrossRefGoogle Scholar
  23. 23.
    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: 15–23.PubMedCrossRefGoogle Scholar
  24. 24.
    Intracranial pressure treatment threshold. Brain Trauma Foundation. J Neurotrauma 1996; 13: 681–3.CrossRefGoogle Scholar
  25. 25.
    Juul N, Moms GF, Marshall SB, Marshall LF. Intracranial hypertension and cerebral perfusion pressure: influence on neurological deterioration and outcome in severe head injury. The Executive Committee of the International Selfotel Trial. J Neurosurg 2000; 92: 1–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Rosner MJ, Rosner SD, Johnson AH. Cerebral perfusion pressure: management protocol and clinical results. J Neurosurg 1995; 83: 949–62.PubMedCrossRefGoogle Scholar
  27. 27.
    Rosner MJ, Daughton S. Cerebral perfusion pressure management in head injury. J Trauma 1990; 30:933–40; discussion 940–1.Google Scholar
  28. 28.
    Muizelaar JP, Marmarou A, Ward JD, Kontos HA, Choi SC, Becker DP, Gruemer H, Young HF. Adverse effects of prolonged hyperventilation in patients with severe head injury: a randomized clinical trial. J Neurosurg 1991; 75: 731–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Diringer MN, Yundt K, Videen TO, Adams RE, Zazulia AR, Deibert E, Aiyagari V, Dacey RG Jr, Grubb RL Jr, Powers WJ. No reduction in cerebral metabolism as a result of early moderate hyperventilation following severe traumatic brain injury. J Neurosurg 2000; 92: 7–13.PubMedCrossRefGoogle Scholar
  30. 30.
    The use of hyperventilation in the acute management of severe traumatic brain injury. Brain Trauma Foundation. J Neurotrauma 1996; 13: 699–703.CrossRefGoogle Scholar
  31. 31.
    Kontos HA, Raper AJ, Patterson JL. Analysis of vasoactivity of local pH, PCO2 and bicarbonate on pial vessels. Stroke 1977; 8: 358–60.PubMedCrossRefGoogle Scholar
  32. 32.
    Yundt KD, Diringer MN. The use of hyperventilation and its impact on cerebral ischemia in the treatment of traumatic brain injury. Crit Care Clin 1997; 13: 163–84.PubMedCrossRefGoogle Scholar
  33. 33.
    Raichle ME, Posner JB, Plum F. Cerebral blood flow during and after hyperventilation. Arch Neurol 1970; 23: 394–403.PubMedCrossRefGoogle Scholar
  34. 34.
    The use of mannitol in severe head injury. Brain Trauma Foundation. J Neurotrauma 1996; 13: 705–9.CrossRefGoogle Scholar
  35. 35.
    Nath F, Galbraith S. The effect of mannitol on cerebral white matter water content. J Neurosurg 1986; 65: 41–3.PubMedCrossRefGoogle Scholar
  36. 36.
    Qureshi AI, Suarez JI, Bhardwaj A, Mirski M, Schnitzer MS, Hanley DF, Ulatowski JA. Use of hypertonic (3%) saline/acetate infusion in the treatment of cerebral edema: Effect on intracranial pressure and lateral displacement of the brain [see comments]. Crit Care Med 1998; 26: 440–6.PubMedCrossRefGoogle Scholar
  37. 37.
    Suarez Jt, Qureshi Al, Bhardwaj A, Williams MA, Schnitzer MS, Mirski M, Hanley DF, Ulatowski JA. Treatment of refractory intracranial hypertension with 23.4% saline. Crit Care Med 1998; 26: 1118–22.PubMedCrossRefGoogle Scholar
  38. 38.
    Horn P, Munch E, Vajkoczy P, Herrmann P, Quintet M, Schilling L, Schmiedek P, Schurer L. Hypertonic saline solution for control of elevated intracranial pressure in patients with exhausted response to mannitol and barbiturates. Neurol Res 1999; 21: 758–64.PubMedGoogle Scholar
  39. 39.
    French LA, Galicich JH. The use of steroids for control of cerebral edema. Clin Neurosurg 1964; 10: 212–223.PubMedGoogle Scholar
  40. 40.
    Alberti E, Hartmann A, Schutz I U, Schreckenberger F. The effect of large doses of dexamethasone on the cerebrospinal fluid pressure in patients with supratentorial tumors. J Neurol 1978; 217: 173–81.PubMedCrossRefGoogle Scholar
  41. 41.
    The role of glucocorticoids in the treatment of severe head injury. Brain Trauma Foundation. J Neurotrauma 1996; 13: 715–8.CrossRefGoogle Scholar
  42. 42.
    Patten BM, Mendell J, Bnrun B, Curtin W, Carter S. Double-blind study of the effects of dexamethasone on acute stroke. Neurology 1972; 22: 377–83.PubMedCrossRefGoogle Scholar
  43. 43.
    Jastremski M, Sutton-Tyrrell K, Vaagenes P, Abramson N, Heiselman D, Safar P. Glucocorticoid treatment does not improve neurological recovery following cardiac arrest. Brain Resuscitation Clinical Trial I Study Group. JAMA 1989; 262: 3427–30.PubMedCrossRefGoogle Scholar
  44. 44.
    The use of barbiturates in the control of intracranial hypertension. Brain Trauma Foundation. J Neurotrauma 1996; 13: 711–4.CrossRefGoogle Scholar
  45. 45.
    Frank JI. Large hemispheric infarction, deterioration, and intracranial pressure. Neurology 1995; 45: 1286–90.PubMedCrossRefGoogle Scholar
  46. 46.
    Cuneo RA, Caronna JJ, Pitts L, Townsend J, Winestock DP. Upward transtentorial herniation: seven cases and a literature review. Arch Neurol 1979; 36: 618–23.PubMedCrossRefGoogle Scholar
  47. 47.
    Morgenstern LB, Frankowski RF, Shedden P, Pasteur W, Grotta JC. Surgical treatment for intracerebral hemorrhage (STICH): a single-center, randomized clinical trial. Neurology 1998; 51: 1359–63.PubMedCrossRefGoogle Scholar
  48. 48.
    Batjer HH, Reisch JS, Allen BC, Plaizier Li, Su CJ. Failure of surgery to improve outcome in hypertensive putaminal hemorrhage. A prospective randomized trial. Arch Neurol 1990; 47: 1103–6.PubMedCrossRefGoogle Scholar
  49. 49.
    Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R. `Malignant’ middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol 1996; 53: 309–15.PubMedCrossRefGoogle Scholar
  50. 50.
    Schwab S, Steiner T, Aschoff A, Schwarz S, Steiner HH, Jansen O, Hacke W. Early hemicraniectomy in patients with complete middle cerebral artery infarction. Stroke 1998; 29: 1888–93.PubMedCrossRefGoogle Scholar
  51. 51.
    Carter BS, Ogilvy CS, Candia GJ, Rosas HD, Buonanno F. One-year outcome after decompressive surgery for massive nondominant hemispheric infarction. Neurosurgery 1997; 40:1168–75; discussion 1175–6.Google Scholar
  52. 52.
    Delashaw JB, Broaddus WC, Kassel) NF, Haley EC, Pendleton GA, Vollmer DG, Maggio WW, Grady MS. Treatment of right hemispheric cerebral infarction by hemicraniectomy. Stroke 1990; 21: 874–81.PubMedCrossRefGoogle Scholar
  53. 53.
    Rengachary SS, Batnitzky S, Morantz RA, Arjunan K, Jeffries B. Hemicraniectomy for acute massive cerebral infarction. Neurosurgery 1981; 8: 321–8.PubMedCrossRefGoogle Scholar
  54. 54.
    Rieke K, Schwab S, Krieger D, von Kummer R, Aschoff A, Schuchardt V, Hacke W. Decompressive surgery in space-occupying hemispheric infarction: results of an open, prospective trial. Crit Care Med 1995; 23: 1576–87.PubMedCrossRefGoogle Scholar
  55. 55.
    Durward QJ, Amacher AL, DelMaestro RF, Sibbald WJ. Cerebral and cardiovascular responses to changes in head elevation in patients with intracranial hypertension. J Neurosurg 1983; 59: 938–44.PubMedCrossRefGoogle Scholar
  56. 56.
    Moraine JJ, Berre J, Melot C. Is cerebral perfusion pressure a major determinant of cerebral blood flow during head elevation in comatose patients with severe intracranial lesions? J Neurosurg 2000; 92: 606–14.PubMedCrossRefGoogle Scholar
  57. 57.
    Kelly DF, Goodale DB, Williams J, Herr DL, Chappell ET, Rosner MJ, Jacobson J, Levy ML, Croce MA, Maniker AH, Fulda GJ, Lovett JV, Mohan O, Narayan RK. Propofol in the treatment of moderate and severe head injury: a randomized, prospective double-blinded pilot trial. J Neurosurg 1999; 90: 1042–52.PubMedCrossRefGoogle Scholar
  58. 58.
    Hsiang JK, Chesnut RM, Crisp CB, Klauber MR, Blunt BA, Marshall LF. Early, routine paralysis for intracranial pressure control in severe head injury: is it necessary? Crit Care Med 1994; 22: 1471–6.PubMedCrossRefGoogle Scholar
  59. 59.
    Vespa PM, Nuwer MR, Nenov V, Ronne-Engstrom E, Hovda DA, Bergsneider M, Kelly DF, Martin NA, Becker DP. Increased incidence and impact of nonconvulsive and convulsive seizures after traumatic brain injury as detected by continuous electroencephalographic monitoring. J Neurosurg 1999; 91: 750–60.PubMedCrossRefGoogle Scholar
  60. 60.
    Bruno A, Biller J, Adams HP, Jr., Clarke WR, Woolson RF, Williams LS, Hansen MD. Acute blood glucose level and outcome from ischemic stroke. Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators. Neurology 1999; 52: 280–4.PubMedCrossRefGoogle Scholar
  61. 61.
    Lam AM, Winn HR, Cullen BF, Sundling N. Hyperglycemia and neurological outcome in patients with head injury. J Neurosurg 1991; 75: 545–51.PubMedCrossRefGoogle Scholar
  62. 62.
    Berger L, Hakim AM. The association of hyperglycemia with cerebral edema in stroke. Stroke 1986; 17: 865–71.PubMedCrossRefGoogle Scholar
  63. 63.
    Zervas NT, Hedley-Whyte J. Successful treatment of cerebral hemiation in five patients. N Engl J Med 1972; 286: 1075–7.PubMedCrossRefGoogle Scholar
  64. 64.
    Qureshi AI, Geocadin RG, Suarez JI, Ulatowski JA. Long-term outcome after medical reversal of transtentorial hemiation in patients with supratentorial mass lesions. Crit Care Med 2000; 28: 1556–64.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Romergryko G. Geocadin
    • 1
  • Michael A. Williams
    • 1
  • Daniel F. Hanley
    • 1
  1. 1.Johns Hopkins University School of MedicineBaltimoreUSA

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