Related Experiment Videos
[Clinical picture and pathophysiology of elevated intracranial pressure]
G Jacobi1, D Klinter, G Weiermann
1Zentrum der Kinderheilkunde, Abteilung für Pädiatrische Neurologie.
Insights
Monitoring intracranial pressure (ICP) in children revealed that vasogenic edema has a better prognosis than cytotoxic edema. Cerebral perfusion pressure below 20 Torr significantly increases unconsciousness and neurological deficits.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Clinical Monitoring
Context:
- Continuous epidural monitoring of intracranial pressure (ICP) in 48 children.
- Correlation of ICP with mean arterial pressure (MAP) and brainstem acoustic evoked responses (BAER).
Purpose:
- To assess the prognostic value of ICP and related parameters in pediatric brain injury.
- To evaluate the utility of BAER in monitoring brainstem function under critical conditions.
Summary:
- Focal lesions causing vasogenic edema show better outcomes than those causing cytotoxic edema, where whole-brain metabolism is impaired.
- Cerebral perfusion pressure (CPP) below 20 Torr correlates with prolonged unconsciousness, increased brainstem symptoms, cranial nerve deficits, and long-term cognitive impairment.
- ICP elevation alone does not correlate with generalized cerebral dysfunction; BAER serial registration aids in managing phenobarbital coma, with specific wave changes indicating brainstem compromise and potential irreversible damage.
Impact:
- Differentiates prognostic outcomes based on edema type (vasogenic vs. cytotoxic).
- Establishes critical CPP thresholds for predicting neurological outcomes and guiding interventions.
- Highlights the role of BAER in detecting early signs of brainstem dysfunction and irreversible damage, crucial for neurocritical care decisions.
Abstract:
In 48 children who had raised intracranial pressure (icp) this was monitored continuously by an epidural route. Icp-values were correlated with other important parameters like the mean arterial pressure (map) and the early components of brainstem acoustic evoked responses (BAER). The results were as follows: 1. focal and multifocal brain lesions resulting in vasogenic brain edema have better prognosis than those morbid conditions causing cytotoxic edema. In the letter group the whole brain's metabolism is impaired, brainstem, cerebellum and spinal cord included. 2. by monitoring map and icp we are enabled to assess the cerebral perfusion pressure. If this value falls short of 20 Torr the duration of unconsciousness and the frequency of brainstem related symptoms increases as well as impairment of cranial nerves and cerebellar-extrapyramidal symptoms and mental handicaps in the long term course. 3. cerebral dysfunction and organic brain syndromes in general are not related to icp-increase. They resemble local brain damage, e.g. after contusions. 4. serial registration of BAER is a good aid in iatrogenic induced deep phenobarbital coma. If there are critical values of the perfusion pressure mainly the waves III and V of BAER have increased peak latencies and go flattened. This trend takes place slowly within hours or even days. Loss of the components III and V is prompted by an irreversible damage of the caudal brainstem. This finding after cytotoxic brain edema is even more relevant than after vasogenic edema. If the component loss III-V is bilateral dissociated brain death has to be anticipated. Some important issues of icp-pathophysiology are discussed according to the literature.