Increased Intracranial Pressure (ICP).
The brain is enclosed in the rigid confines of the skull, or cranium, making it particularly susceptibleto increases in ICP. Increased ICP is a common pathway for brain injury from different types of insults and agents. Excessive ICP obstruct cerebral blood flow, destroy brain cells, displace braintissue as in herniation, and otherwise damage delicate brain structures.The cranial cavity contains blood (approximately 10%), brain tissue (approximately 80%), and CSF(approximately 10%) in the rigid confines of a nonexpendable skull. Each of these volumescontributes to the ICP, which normally is maintained within a range of 0 to 15 mm Hg whenmeasured in the lateral ventricles. The volumes of each of these components can vary slightlywithout causing marked changes in ICP. This is because small increases in the volume of thecomponent can be compensated for a decrease in the volume of one or both of the other twocomponents. This association is called the
Normal fluctuation in ICP occurwith respiratory movements and activities of daily living such as straining, coughing, and sneezing.Abnormal variation in intracranial volume with subsequent changes in ICP can be caused by avolume change in any of the three intracranial components. For example, an increase in tissuevolume can result from a brain tumor, brain edema, or bleeding into brain tissue. An increase inblood volume develops when there is vasodilation of cerebral vessels or obstruction of venousoutflow. Excess production, decrease absorption, or obstructed circulation of CSF affords thepotential for an increase in the CSF component. When the change in volume is caused by a braintumor, it tends to occur slowly and usually is localized to the immediate area, whereas the increaseresulting from head injury usually develops rapidly.According to the modified Monro-Kellie hypothesis, reciprocal compensation occurs among thethree intracranial compartments. Of the three intracranial volumes, tissue volume is relativelyrestricted in its ability to udergo change; CSF and blood volume are best able to compensate forchanges in ICP. Initial increases in ICP are buffered by a translocation of CSF to the spinalsubarachnoid space and increased reabsorption of CSF. The compensatory ability of the bloodcompartment is limited by a small amount of blood that is in the cerebral circulation. The cerebralblood vessels contain less than 10% of the intracranial volume, most of which is contained in thelow-pressure venous system. As the volume-buffering capacity of this compartment becomesexhausted, venous pressure increases, and cerebral blood volume and ICP rise. Also, cerebral bloodflow is highly controlled by autoregulatory mechanisms, which affects its compensatory capacity.Conditions such as ischemia and elevated partial pressure of carbon dioxide (PCO2) in the bloodproduce a compensatory vasodilation of the cerebral blood vessels. A decrease in PCO2 has theopposite effect; for this reason, hyperventilation, which results in a decrease in PCO2 levels, is somesused in the treatment of ICP.
BRAIN INJURY: INCREASED INTRACRANIAL PRESSURE AND HERNIATIONMEDICALVILLAGE.BLOGSPOT.COM SPECIAL MEDICAL REPORT PART 2