Abstract
Summary Simultaneous continuous monitoring of ventricular-fluid pressure (V.F.P.) and systemic arterial pressure (S.A.P.) was carried out in 32 patients following a severe head injury. Normal, moderately elevated, and high pressure groups were recognised. All groups showed a high mortality, particularly the high-pressure group, of whom half showed evidence of less serious brain damage immediately after injury and then deteriorated. The response of S.A.P. to raised V.F.P. was variable, and high V.F.P. levels could be sustained without alteration in S.A.P. Mannitol and surgical decompression were variable in their effects on raised V.F.P. Aspiration of ventricular cerebrospinal fluid was very effective in cases not responding to other measures. Clinical evidence of raised intracranial pressure is unreliable after severe head injury, and management can be much moresecurely based if intracranial pressure is directly and continuously measured.
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