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Intracranial pressure (ICP) is the pressure exerted by fluids such as cerebrospinal fluid (CSF) inside the skull and on the brain tissue. ICP is measured in millimeters of mercury and at rest, is normally 7–15 mmHg for a supine adult. This equals to 9–20 cmH 2 O, which is a common scale used in lumbar punctures. [1]
An alternative definition of CPP is: [1] = where: MAP is mean arterial pressure ICP is intracranial pressure JVP is jugular venous pressure. This definition may be more appropriate if considering the circulatory system in the brain as a Starling resistor, where an external pressure (in this case, the intracranial pressure) causes decreased blood flow through the vessels.
It can cause complications such as vision impairment due to intracranial pressure , permanent neurological problems, reversible neurological problems, seizures, stroke, and death. [1] However, aside from a few Level I trauma centers, ICP monitoring is rarely a part of the clinical management of patients with these conditions.
Cushing reflex (also referred to as the vasopressor response, the Cushing effect, the Cushing reaction, the Cushing phenomenon, the Cushing response, or Cushing's Law) is a physiological nervous system response to increased intracranial pressure (ICP) that results in Cushing's triad of increased blood pressure, irregular breathing, and bradycardia. [1]
Under normal conditions, regular movements such as leaning forward, normal heartbeat and breathing can cause changes to the ICP. Intracranial monitoring accounts for this by averaging measurements over 30 minutes in non-comatose patients. Readings between 7-15mmHg are considered normal in an adult, 3-7mmHg in children, and 1.4-6mmHg in infants. [4]
The pulse may vary due to exercise, fitness level, disease, emotions, and medications. [11] The pulse also varies with age. A newborn can have a heart rate of 100–160 bpm, an infant (0–5 months old) a heart rate of 90–150 bpm, and a toddler (6–12 months old) a heart rate of 80–140 bpm. [ 12 ]
This leads to an increase in intracranial pressure (ICP). The ICP gradually falls but remains slightly elevated, and the CSF pressure reaches a high normal level of 15 to 20 cm H 2 O. Measurements of ICP, therefore, are not usually elevated. Because of this, patients do not exhibit the classic signs that accompany increased intracranial ...
Low-pressure hydrocephalus (LPH) is a condition whereby ventricles are enlarged and the individual experiences severe dementia, inability to walk, and incontinence – despite very low intracranial pressure (ICP). [1] Low pressure hydrocephalus appears to be a more acute form of normal pressure hydrocephalus. If not diagnosed in a timely ...