When intracranial pressure is monitored with a ventricular catheter, regular waves due to pulse and respiratory effects are recorded (page 51). As an intracranial mass expands and as the compensatory reserves diminish, transient pressure elevations (pressure waves) are superimposed. These become more frequent and more prominent as the mean pressure rises.
Eventually the rise in intracranial pressure and resultant fall in cerebral perfusion pressure reach a critical level and a significant reduction in cerebral blood flow occurs. Electrical activity in the cortex fails at flow rates about 20 ml/100 g/min. If autoregulation is already impaired these effects develop even earlier. When intracranial pressure reaches the mean arterial blood pressure, cerebral blood flow ceases.
Many factors affect intracranial pressure and these should not be considered in isolation. Inter-relationships are complex and feedback pathways may merely serve to compound the brain damage.
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