Related Experiment Video
Updated: Jun 2, 2026
06:18
A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019
Raised intracranial pressure with upright posture.
Miu Fei Lam1, Bryant Allan Rigby Stokes, Christopher Raymond Peter Lind
1Department of Neurosurgery, Sir Charles Gairdner Hospital, Perth, Australia.
Summary
Idiopathic intracranial hypertension can paradoxically increase intracranial pressure (ICP) when upright, despite normal pressure when lying down. Surgical decompression improved outcomes for a patient with this condition.
Area of Science:
- Neurology
- Neurosurgery
Background:
- Idiopathic intracranial hypertension (IIH) is a condition characterized by elevated intracranial pressure (ICP) without a clear cause.
- Management of IIH often involves shunting procedures, such as lumboperitoneal shunts, to reduce ICP.
Observation:
- A patient with a lumboperitoneal shunt for IIH presented with paradoxical intracranial hypertension.
- This phenomenon involved elevated ICP specifically in the upright posture, with normal ICP when recumbent.
Findings:
- Direct ICP monitoring confirmed the postural variation in intracranial pressure.
- Bilateral subtemporal surgical decompression was performed to enhance intracranial compliance.
- Perioperative ICP monitoring validated the effectiveness of the surgical intervention.
Implications:
- This case highlights a rare presentation of IIH with significant postural ICP changes.
- Surgical decompression may be a viable treatment option for select patients with refractory or complex IIH.
- Understanding postural ICP dynamics is crucial for managing certain intracranial pressure disorders.
Related Concept Videos
01:14Increased Intracranial Pressure l: Introduction
Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...
01:29Increased Intracranial Pressure ll: Pathophysiology
Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...
01:22Cerebral Edema ll: Pathophysiology
Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this barrier loses...
01:19Cerebral Edema l: Introduction
Cerebral edema is a pathological increase in brain water content that disrupts intracranial pressure regulation and impairs neurological function. Because the cranial vault is rigid, even modest increases in tissue volume can compromise cerebral perfusion, distort neural structures, and initiate secondary injury. Cerebral edema develops through four principal mechanisms: vasogenic, cytotoxic, interstitial, and ionic.Vasogenic EdemaVasogenic edema arises from disruption of the blood–brain...
01:11Anatomical Positions
In anatomy, several standard anatomical positions are used as references for describing the position and orientation of different body parts. These positions help provide a common frame of reference when discussing anatomical structures. The anatomical position is the standard reference point for describing the body's position and orientation. In this position:
The body is upright, facing forward, and standing erect.
The feet are parallel and flat on the floor.
The arms are hanging by the...
The body is upright, facing forward, and standing erect.
The feet are parallel and flat on the floor.
The arms are hanging by the...
01:25Glaucoma: Overview
Glaucoma is an eye condition characterized by increased intraocular pressure that damages the retina and optic nerve, leading to irreversible blindness if left untreated. The human eye has various components, including the cornea, iris, pupil, lens, and optic nerve. Aqueous humor is secreted by the epithelium of the ciliary body in the posterior chamber and flows through the trabecular meshwork and canal of Schlemm, maintaining normal intraocular pressure. The trabecular meshwork and the canal...