Management of Intracranial Pressure in Traumatic Brain Injury

Abstract

Traumatic brain injury (TBI) is the result of an external force acting upon the head, causing damage to the brain. The severity of injury, mechanism by which the injury occurs, and the frequency of the high-force impact all play a role in the determination of a TBI. TBI describes a wide range of traumatic pathologies which is comprised of damage done to a multitude of cranial central nervous system components. TBI patients typically present with a series of symptoms are correlated with the presence of an intracranial injury, such as physical/cognitive difficulties. A major concern associated with intracranial injuries is the management of intracranial pressure (ICP), a resulting factor of a TBI which facilitates into intracranial hematoma and/or cerebral edema. These conditions have adverse effects on one's brain, and the immediate management and relief of intracranial pressure are crucial in avoiding hydrocephalus and brain herniation, conditions which lead to sensory loss and even death. In this chapter, we will begin by thoroughly understanding what a TBI is, its clinical presentation, and the first-tier examination to determine severity. Then, we will progress into the anatomy of the brain, followed by a thorough investigation into intracranial pressure management strategies and prognosis.

Variations in Information Flow Patterns Following Intracranial Hypertensive Events in Traumatic Brain Injured Patients

“…According to the Monro-Kellie hypothesis, an increase in ICP can be controlled by decreasing CPP. This decrease in CPP dictates that there is a decrease in blood pressure which subsequently results in initiating auto-regulation of ICP [66]. When ICP rises above 16 mmHg, the brain blood vessels constrict to reduce the blood flow to the cranium, and ultimately reduce the ICP.…”

“…When ICP rises above 16 mmHg, the brain blood vessels constrict to reduce the blood flow to the cranium, and ultimately reduce the ICP. Therefore, when homeostatic functions of the brain are lost due to traumatic brain injury, the ICP increases and physiological regulatory functions are inoperable [66], [67]. This degree of impairment of auto-regulation might be directly associated with the onset of an IH event, resulting in intra-individual variability.…”

A Novel Method for Prediction of Raised Intracranial Pressure Through Automated ONSD and ETD Ratio Measurement From Ocular Ultrasound

“…The normal ICP range in healthy patients is 5 to 15 mm of Hg. [1][2][3][4] Regular monitoring of ICP is needed in case of accidental damage to the brain, as it causes ICP to rise; this raised ICP in the brain reduces cerebral perfusion pressure (CPP), which results in brain damage. [5][6][7] The measurement of intracranial pressure can be performed through invasive and non-invasive methods, but the invasive techniques are complex and harmful to patients; they include ventriculostomy and micro transducers for continuous ICP monitoring.…”