Intracranial pressure

NICEM consensus on neurological monitoring in acute neurological disease

Authors: Peter J. D. Andrews, Giuseppe Citerio, Luca Longhi, Kees Polderman, Juan Sahuquillo, Peter Vajkoczy and Neuro-Intensive Care and Emergency Medicine (NICEM) Section of the European Society of Intensive Care Medicine

This manuscript summarises the consensus on neuromonitoring in neuro-intensive care promoted and organised by the Neuro-Intensive Care and Emergency Medicine (NICEM) Section of the European Society of Intensive Care Medicine (ESICM). It is expected that continuous monitoring using multi-modal techniques will help to overcome the limitations of each individual method and will provide a better diagnosis. More specific treatment can then be applied; however, it remains to be determined which combination of parameters is optimal. The questions discussed and addressed in this manuscript are: (1) Who should have ICP monitoring and for how long? (2) What ICP technologies are available and what are their relative advantages/disadvantages? (3) Should CPP monitoring and autoregulation testing be used? (4) When should brain tissue oxygen tension (PbrO2) be monitored? (5) Should structurally normal or abnormal tissue be monitored with PbrO2? (6) Should microdialysis be considered in complex cases? It is hoped that this document will prove useful to clinicians working in NICU and also to those developing specialist NICU services within their hospital practice.

Monitoring Intracranial Pressure in Traumatic Brain Injury

Authors: Martin Smith, MBBS, FRCA

Increased intracranial pressure (ICP) is an important cause of secondary brain injury, and ICP monitoring has become an established component of brain monitoring after traumatic brain injury. ICP cannot be reliably estimated from any specific clinical feature or computed tomography finding and must actually be measured. Different methods of monitoring ICP have been described but intraventricular catheters and microtransducer systems are most widely used in clinical practice. ICP is a complex variable that links ICP and cerebral perfusion pressure and provides additional information from identification and analysis of pathologic ICP wave forms. ICP monitoring can also be augmented by measurement of indices describing cerebrovascular pressure reactivity and pressure-volume compensatory reserve. There is considerable variability in the use of ICP monitoring and treatment modalities among head injury centers. However, there is a large body of clinical evidence supporting the use of ICP monitoring to detect intracranial mass lesions early, guide therapeutic interventions, and assess prognosis, and it is recommended by consensus guidelines for head injury management. There remains a need for a prospective, randomized, controlled trial to identify the value of ICP monitoring and management after head injury. (Anesth Analg 2008;106:240 –8)

Noninvasive Monitoring of Intracranial Pressure

Authors: Djordje Popovic1,3,*, Michael Khoo1 and Stefan Lee 2

(1Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, 2 Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, 3 Advanced Brain Monitoring Inc., Carlsbad, CA)

Recent Patents on Biomedical Engineering 2009, 2, 165-179
Received: April 29, 2009; Accepted: May 6, 2009; Revised: May 9, 2009

Increased intracranial pressure (ICP) is one of the major causes of secondary brain ischemia that accompanies a variety of pathological conditions, most notably, traumatic brain injury (TBI), stroke, and intracranial hemorrhages. However, aside from a few Level I trauma centers, ICP monitoring is rarely a part of the clinical management of patients with these conditions because of the invasiveness of the standard monitoring methods (which require insertion of a catheter into the cranium), additional risks they present for patients, high costs associated with the procedure, and the limited access to trained personnel, i.e., a neurosurgeon. Alternative methods have therefore been sought with which ICP can be measured noninvasively. This article reviews nearly 30 such methods patented over the past 25 years, which included ultrasound “time-of-flight” techniques, transcranial Doppler, methods based on acoustic properties of the cranial bones, EEG, MRI, tympanic membrane displacement, oto-acoustic emission, ophthalmodynamometry, and ultrasound measurements of optic nerve sheath diameter. At present, none of the methods is sufficiently accurate to allow for routine clinical use although several hold promise. Future developments should integrate further refinements of the existing methods, combined use of multiple sensors and/or technologies, and large clinical validation studies on relevant populations.  

Intracranial pressure and glaucoma

Authors: Berdahl, John Pa; Allingham, R Randb

Current Opinion in Ophthalmology: March 2010 - Volume 21 - Issue 2 - p 106–111 doi: 10.1097/ICU.0b013e32833651d8 Glaucoma: Edited by Donald L. Budenz

Purpose of review: Glaucoma remains a disease with an unclear basic pathophysiology. The optic nerve travels through two pressurized regions: the intraocular space and the intracranial space. Some authors have suggested that the relationship between intraocular pressure and intracranial pressure may play a fundamental role in the development of glaucoma.

Recent findings: Recent studies have shown that intracranial pressure is lower in patients with glaucoma and normal-tension glaucoma. Conversely, intracranial pressure appears to be elevated in patients with ocular hypertension. Early mathematical modeling studies have suggested that the counterbalance provided by intracranial pressure would be an important factor in the development of glaucoma.

Summary: The relationship between intraocular pressure and intracranial pressure may play an important role in the development of glaucoma.

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