Raised Intracranial Pressure


A degree of upw herniation is usi



A degree of upw herniation is usi



Brainstem pressure results in:

- depression of conscious level.

- respiratory irregularities->

respiratory arrest impaction in the '

foramen magnum produces neck stiffness and head tilt

An injudicious lumbar puncture in the presence of a subtentorial mass may create a pressure gradient sufficient to induce tonsillar herniation.

N.B. Harvey Cushing described cardiovascular changes - an increase in blood pressure and a fall in pulse rate, associated with an expanding intracranial mass, and probably resulting from direct medullary compression. The clinical value of these observations is often overemphasised. They are often absent; when present they are invariably preceded by a deterioration in conscious level.


Patients with suspected raised intracranial pressure require an urgent CT scan. Intracranial pressure monitoring where appropriate (see page 51).


When a rising intracranial pressure is caused by an expanding mass, or is compounded by respiratory problems, treatment is clear-cut; the mass must be removed and blood gases restored to normal levels - by ventilation if necessary.

In some patients, despite the above measures, cerebral swelling may produce a marked increase in intracranial pressure. This may follow removal of a tumour or haematoma or may complicate a diffuse head injury. Artificial methods of lowering intracranial pressure may prevent brain damage and death from brain shift, but some methods lead to reduced cerebral blood flow, which in itself may cause brain damage (see page 80).

Intracranial pressure is monitored with a ventricular catheter or surface pressure recording device (see page 50).

Treatment may be instituted when the mean ICP is > 30 mmHg.

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