Management of Elevated Intracranial Pressure

Intracranial hypertension is defined as an ICP >15 mmHg. A progressive rise from this level, or sustained ICP >20 mmHg, should prompt investigation and treatment. A progressive rise in ICP may indicate the development of hemorrhage/hematoma, edema, hydrocephalus or a combination of these causes, and an immediate CT scan is indicated. A sustained elevated ICP increases the risk of secondary injury from ischemia and/or herniation.

In patients with surgically correctable pathology, such as subdural/epidural/intracerebral hematoma, or hydrocephalus, prompt surgical treatment is indicated. In other patients ICP can be effectively controlled by manipulating the different compartments of the intracranial contents. In patients refractory to medical management, decompressive craniectomy is indicated. These approaches are discussed below and summarized in Table 5.1.

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