A translational perspective on intracranial pressure responses following intracerebral hemorrhage in animal models

Abstract

As with ischemic and traumatic brain injury, raised intracranial pressure (ICP) is a common life-threatening complication of intracerebral hemorrhage (ICH). Elevated ICP can lead to cerebral ischemia, impaired cerebrospinal fluid flow, and brain herniation. Compliance mechanisms accommodate to mitigate raised ICP, but these mechanisms are often overwhelmed after large ICH, and thus treatments are needed to lower ICP. Rodents, canines, and non-human primates have been used to model ICH and study both the consequences of and treatments for high ICP. However, the methods used to study ICP can be expensive and technically challenging, leading to a scarcity of research in the area. Similarly, replication among labs is difficult owing to differences in ICP devices, measurement location, and data analysis. Many treatments to lower ICP have been investigated, some of which are currently used in clinical practice, such as surgical interventions and osmotic therapies, but strong evidence is often lacking. Here we review the mechanistic importance of raised ICP in determining poor outcome after ICH, and specifically the difficulties of accurately modeling and measuring ICP in preclinical research, and how this might affect research translation.