Dynamics of Intracranial Pressure Rise in Severely Head Injured Patients

Abstract

Our work and studies by other investigators have shown that the single most frequent cause of death in aggressively managed head injured patients is uncontrollable intracranial hypertension (Becker 1977, Marshall 1979). Studies in Richmond indicate thathigh ICP was initially present in two-thirds of those patients without intracranial spaceoccupying lesions who were comatose upon admission. Half of the patients who developed intracranial hypertension, or in whom elevated ICP persisted, died despite therapy. Raised ICP continues as the most frequent cause of death in head injury yet the sequence of events which leads to raised ICP is poorly understood. Our studies of ICP dynamics implicate at least three parameters which contribute to the level of pressure; the rate of fluid formation (If), the outflow resistance offered to the egress of fluid (Ro), and a component (Pv) identifying the vascular contribution to ICP. The objective of this study was to measure the changes in these parameters in head-injured patients and determine the relative contribution of CSF and vascular components to the ICP.

This project was funded by the National Institutes of Health, NS-12587