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A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019
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Raised intracranial pressure and brain edema
Ville Leinonen1, Ritva Vanninen2, Tuomas Rauramaa3
1Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland and Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
Handbook of Clinical Neurology
|October 9, 2017
Summary
Acutely increased intracranial pressure (ICP) is a critical neurosurgical emergency. Understanding causes like brain bleeds and edema is key for effective management and predicting patient recovery outcomes.
Area of Science:
- Neurosurgery
- Neurology
- Pathophysiology
Background:
- Acutely increased intracranial pressure (ICP) presents a life-threatening neurosurgical emergency.
- Management strategies are dictated by the underlying causative process, including various intracranial hemorrhages and hydrocephalus.
- Brain parenchyma injury can lead to edema, progressively increasing ICP and worsening clinical status.
Purpose of the Study:
- To review the diverse causes of acutely increased intracranial pressure (ICP).
- To elucidate the mechanisms of brain edema formation and its role in elevating ICP.
- To provide clinical examples illustrating these concepts.
Main Methods:
- Literature review of causes for elevated ICP.
- Discussion of intracranial bleeds (e.g., subdural, epidural, intracerebral hematoma) and hydrocephalus.
- Explanation of brain edema mechanisms (cytotoxic, ionic, vasogenic).
Main Results:
- Optimal management depends on the specific cause of increased ICP.
- Full recovery is possible with prompt treatment before herniation, especially without significant brain injury.
- Intraparenchymal injuries often result in incomplete recovery due to cell death and replacement by cerebrospinal fluid.
Conclusions:
- Brain edema, a continuum of swelling, significantly contributes to increased ICP in various neurological conditions.
- Understanding the pathophysiology of increased ICP and brain edema is crucial for neurosurgical management.
- Clinical outcomes are influenced by the extent of brain injury and the effectiveness of ICP management.
