Abstract
Intracranial pressure (ICP) measurements are essential in evaluation and treatment of neurological disorders such as subarachnoid and intracerebral hemorrhage, ischemic stroke, hydrocephalus, meningitis/encephalitis, and traumatic brain injury (TBI). The techniques of ICP monitoring have evolved from invasive to non-invasive—with both limitations and advantages. Some limitations of the invasive methods include short-term monitoring, risk of infection, restricted mobility of the subject, etc. The invasiveness of a method limits the frequency of ICP evaluation in neurological conditions like hydrocephalus, thus hampering the long-term care of patients with compromised ICP. Thus, there has been substantial interest in developing noninvasive techniques for assessment of ICP. Several approaches were reported, although none seem to provide a complete solution due to inaccuracy. ICP measurements are fundamental for immediate care of TBI patients in the acute stages of severe TBI injury. In severe TBI, elevated ICP is associated with mortality or poor clinical outcome. ICP monitoring in conjunction with other neurological monitoring can aid in understanding the pathophysiology of brain damage. This review article presents: (a) the significance of ICP monitoring; (b) ICP monitoring methods (invasive and non-invasive); and (c) the role of ICP monitoring in the management of brain damage, especially TBI.
Highlights
Intracranial pressure (ICP) is a resultant of the pressure applied by the components within an inflexible and rigid skull
Changes in ICP are dependent on factors such as the expansion of intracranial volume, volume distribution of the components (brain, blood, cerebrospinal fluid (CSF), lesions, edema, etc.), elasticity of the components, and the presence of lesions
A statistically significant correlation was found between pulsatility index (PI) and ICP (r2 = 0.6, p = 0.0001) and it was concluded that Transcranial Doppler (TCD) is a valid method for predicting the outcome after 6 months of severe head injury
Summary
Intracranial pressure (ICP) is a resultant of the pressure applied by the components within an inflexible and rigid skull. 2015, 16, 28979–28997 proven to be valuable, often lifesaving, in the acute care of TBI [13], hydrocephalus [14], drowning [15] inflammatory and related cerebral diseases such as Reye’s syndrome [16], intracranial hemorrhage [17], cryptococcal meningitis [18], and postoperative sub-occipital brain tumors [19]. Sci. 2015, 16, 28979–28997 proven to be valuable, often lifesaving, in the acute care of TBI [13], hydrocephalus [14], drowning [15] inflammatory and related cerebral diseases such as Reye’s syndrome [16], intracranial hemorrhage [17], cryptococcal meningitis [18], and postoperative sub-occipital brain tumors [19] Most of these patients have headaches and other symptoms suggestive (but not always indicative) of raised ICP and continuous access to ICP levels may greatly facilitate their management.
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