Recognition and Management of Intracranial Hypertension

INVITED REVIEW

J Neurocrit Care 2008;1(1): 87-100.

Axel J. Rosengart, MD, PhD¹, Sea Mi Park, MD, PhD², Alan Z. Segal, MD¹ and Matthew E. Fink, MD¹

¹Neuroscience Critical Care Program, Department of Neurology and Neurosurgery, New York Presbyterian Hospital-Weill Cornell Medical College New York, NY, USA, ²Department of Neurology, Asan Medical Center, Seoul, Korea

Recognition and Management of Intracranial Hypertension

Axel J. Rosengart, MD, PhD¹ Sea Mi Park, MD, PhD², Alan Z. Segal, MD¹ and Matthew E. Fink, MD¹

ABSTRACT

Intracranial hypertension, that is, the sustained elevation of pressure within the cranium, can be the result of a primary central nervous system process, or a secondary complication of a concurrent systemic illness. Independent of the underlying etiology, unremitting elevation of intracranial pressure (ICP) represents an absolute emergency that not infrequently results in disabling and deadly consequences if left unattended. Advances in the understanding of the underlying pathophysiology and dynamics of ICP-provoking injury and recent progress in the treatment of severe, intractable ICP elevations allows the astute clinician to protect the brain from secondary injury and to improve outcome. Unfortunately, however, the management of intracranial hypertension is frequently approached in an overly simplistic manner, starting not only with the common denial and inexperience of physicians to detect and monitor raised ICP but also with the sequential application of various ICP lowering strategies in a cookbook-like fashion. In contrast, dedicated management of intracranial hypertension is best tailored to patient’s individual situation and to the continuous changes in response to neuromedical and neurosurgical therapeutic maneuvers. This overview will review both the basic and advanced principles that should be considered when arriving at an individualized strategic management plan for a patient with brain swelling and/or intracranial hypertension.

Key Words: Brain swelling·Herniation·Treatment