Intracranial Pressure Monitoring

NORMAL PRESSURE TRACE

10 r mmHg 0

Note waves caused by pulse pressure and respiration

Normal I CP < 10mm Hg

10 sec

Fluctuations in blood pressure may cause waves of 5-8/min (Traube-Hering waves).

ABNORMAL PRESSURE TRACE

Look for: Increase in the mean pressure - > 20 mmHg - moderate elevation

> 40 mmHg - severe increase in pressure N.B. As ICP increases, the amplitude of the pulse pressure wave increases.

mmHg

5 min

Frequency '/2-2/min Of variable amplitude Often related to respiration

Plateau waves

100 r mmHg 50

Elevation of ICP over 50 mmHg lasting 5-20 minutes Precede a severe continuous rise in ICP and precursors of further clinical deterioration

10 min

10 min

Elevation of ICP over 50 mmHg lasting 5-20 minutes Precede a severe continuous rise in ICP and precursors of further clinical deterioration

CLINICAL USES OF ICP MONITORING

- Investigation of normal pressure hydrocephalus - the presence of (3 waves for >5% of a 24-hour period suggests impaired CSF absorption and the need for a drainage operation.

- Postoperative monitoring - a rise in ICP may precede clinical evidence of haematoma formation or cerebral swelling.

- Small traumatic haematomas - ICP monitoring may guide management and indicate the need for operative removal.

- ICP monitoring is required during treatment aimed at reducing a raised ICP and maintaining cerebral perfusion pressure.

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