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Increased Intracranial Pressure l: Introduction

Increased 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...

Increased Intracranial Pressure ll: Pathophysiology

Increased 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...

Herniated Intervertebral Disc l: Introduction

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Intervertebral disc herniation refers to the displacement of the nucleus pulposus (the gel-like inner core of the disc) through a tear or weakened area in the annulus fibrosus (the outer fibrous ring). The displaced disc material extends beyond the normal boundaries of the disc space and may compress or irritate nearby spinal nerve roots or, less commonly, the spinal cord.Etiology and Risk FactorsHerniation commonly results from degeneration, in which aging reduces disc hydration and...

Cerebral Edema ll: Pathophysiology

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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...

Local Anesthetics: Clinical Application as Spinal Anesthesia

Local Anesthetics: Clinical Application as Spinal Anesthesia

Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...

Cerebrospinal Fluid

Cerebrospinal Fluid

Cerebrospinal fluid (CSF) is a colorless liquid that flows around the brain and the spinal cord, playing a vital role in the protection, support, and overall function of the central nervous system (CNS). CSF production, circulation, and absorption are tightly regulated processes essential for the brain and spinal cord to function properly.
CSF Production
CSF is produced mainly in the choroid plexus, a network of capillaries and ependymal cells located within the ventricular system of the brain....

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Updated: Apr 30, 2026

Intrathecal Application of a Fluorescent Dye for the Identification of Cerebrospinal Fluid Leaks in Cochlear Malformation

Intrathecal Application of a Fluorescent Dye for the Identification of Cerebrospinal Fluid Leaks in Cochlear Malformation

Published on: February 29, 2020

Low-pressure/spinal fluid leak headache.

Roderick C Spears¹

¹Center for Headache Management, Crozer Chester Medical Center, 1 Medical Center Blvd., Upland, PA, 19013, USA, rc12sster@gmail.com.

Current Pain and Headache Reports

|April 25, 2014

Summary

Low cerebrospinal fluid (CSF) pressure causes neurological issues, most commonly orthostatic headaches. Spontaneous intracranial hypotension (SIH) is increasingly recognized and treated with epidural blood patches.

Area of Science:

Neurology
Neurosurgery

Background:

Low cerebrospinal fluid (CSF) pressure can cause significant neurological deficits.
Headaches, particularly orthostatic headaches, are the most common symptom.

Purpose of the Study:

To review the pathophysiology, diagnosis, and treatment of spontaneous intracranial hypotension (SIH).
To highlight the increasing recognition of SIH and its clinical manifestations.

Main Methods:

Review of existing literature on SIH.
Discussion of diagnostic imaging, primarily MRI with gadolinium.
Overview of treatment modalities, including conservative measures, epidural blood patch (EBP), and surgical options.

Main Results:

SIH is characterized by orthostatic headache and other symptoms like nausea and visual disturbances.

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Intraoperative Ultrasound in Spinal Surgery

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Last Updated: Apr 30, 2026

Intrathecal Application of a Fluorescent Dye for the Identification of Cerebrospinal Fluid Leaks in Cochlear Malformation

Intrathecal Application of a Fluorescent Dye for the Identification of Cerebrospinal Fluid Leaks in Cochlear Malformation

Published on: February 29, 2020

Spinal Hernia Repair and Cauda Equina Repositioning After Lumbar Decompression under Three-Dimensional Microscopy: A Case Report and Literature Review

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Intraoperative Ultrasound in Spinal Surgery

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MRI findings often include diffuse pachymeningeal enhancement and cerebellar tonsillar descent.

Epidural blood patch (EBP) is the primary treatment, with surgery as an alternative for refractory cases.

Conclusions:

Spontaneous intracranial hypotension (SIH) is a recognized cause of neurological symptoms, especially orthostatic headaches.
Early diagnosis via MRI and prompt treatment with EBP are crucial for patient outcomes.