Traumatic Brain Injury

Slope of the intracranial pressure waveform after traumatic brain injury

Authors: Franklin D. Westhout, MD, Laura S. Paré, MD, FRCSC, Ralph J. Delfino, MD, PhD, Steven C. Cramer, MD

Published online "Surgical Neurology" 13 February 2008.

Greater systolic ICP waveform slope during inspiration has not been described previously after TBI and is consistent with prior observations in subjects with hydrocephalus. The strong correlation between ICP slope and simultaneous mean ICP suggests that increasing ICP slope might indicate loss of intracranial compliance after TBI. 

Relationship between Intracranial Pressure and Cortical Spreading Depression following Fluid Percussion Brain Injury in Rats

Authors: G.G. Rogatsky, J. Sonn, Y. Kamenir, N. Zarchin, A. Mayevsky. Journal of Neurotrauma. December 2003.

The rising number of cortical spreading depression (CSD) cycles under condition of an ICP level ≥20 mm Hg may demonstrate, with high probability, the unfavorable development of TBI, caused by growing secondary hypoxic insult.

Monitoring Intracranial Pressure in Traumatic Brain Injury

Authors: Martin Smith, MBBS, FRCA

Increased intracranial pressure (ICP) is an important cause of secondary brain injury, and ICP monitoring has become an established component of brain monitoring after traumatic brain injury. ICP cannot be reliably estimated from any specific clinical feature or computed tomography finding and must actually be measured. Different methods of monitoring ICP have been described but intraventricular catheters and microtransducer systems are most widely used in clinical practice. ICP is a complex variable that links ICP and cerebral perfusion pressure and provides additional information from identification and analysis of pathologic ICP wave forms. ICP monitoring can also be augmented by measurement of indices describing cerebrovascular pressure reactivity and pressure-volume compensatory reserve. There is considerable variability in the use of ICP monitoring and treatment modalities among head injury centers. However, there is a large body of clinical evidence supporting the use of ICP monitoring to detect intracranial mass lesions early, guide therapeutic interventions, and assess prognosis, and it is recommended by consensus guidelines for head injury management. There remains a need for a prospective, randomized, controlled trial to identify the value of ICP monitoring and management after head injury. (Anesth Analg 2008;106:240 –8)

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