Table 2 Possible mechanisms of raised ICP that involve increase in one or more of the contents of the skull: blood (arterial or venous), CSF (hydrocephalus), or brain parenchyma (interstitial edema or tumor). ARDS: acute respiratory distress syndrome; SDH: subdural hemorrhage
From: Intracranial pressure for clinicians: it is not just a number
Compartment involved in raised ICP | Cause of raised ICP | Possible adequate treatment |
|---|---|---|
CSF | Increased production (rare) or reduced absorption | CSF drainage |
Blood | Obstructed venous outflow (i.e. head positioning, sinuses thrombosis or compression, ARDS, prone positioning, abdominal compartment syndrome) | Repositioning of the head Adjust ventilation Neuromuscular blockage Venous thrombectomy or stent Anticoagulants Abdominal surgery |
Arterial vasodilation (impaired autoregulation) | Brief hyperventilation Vasoconstrictor drugs increase | |
Bleeding | Appropriate treatment based on the source (i.e. coiling/clipping of aneurysms, evacuation and hemostasis for SDH) | |
Parenchyma | Interstitial edema | Mannitol, hypertonic saline, decompressive craniectomy |
Tumor/other mass lesions | Steroids Surgical excision |