Management of Intracranial Pressure

Area of Science:

• Neurology
• Neurosurgery
• Critical Care Medicine

Background:

• Intracranial pressure (ICP) elevation, or intracranial hypertension, is a critical condition defined as sustained ICP > 20 mm Hg.
• It is associated with various neurological insults including traumatic brain injury, stroke, hemorrhage, neoplasms, and diffuse cerebral disorders.

Purpose of the Study:

• To review the diagnosis and management of elevated intracranial pressure.
• To highlight the importance of timely recognition and intervention to prevent adverse outcomes.

Main Methods:

• Invasive ICP monitoring via external ventricular drains or intraparenchymal probes.
• Clinical assessment for signs and symptoms of elevated ICP.

Main Results:

• Clinical manifestations range from headache and papilledema to coma and cardiopulmonary arrest.
• Effective management hinges on identifying the underlying cause.

Conclusions:

• Treatment strategies include medical interventions (e.g., osmotic therapy, hyperventilation) and surgical options (e.g., CSF drainage, lesion decompression).
• Refractory cases may require advanced support like mechanical ventilation and paralysis.
• Future research directions include hypothermia and novel pharmacologic and surgical approaches.