INCEASED
INTRACRANIAL
PRESSURE
BY
DR SAM KINAKO
OUTLINE
• Definition
• Etiology
• Pathophysiology
DEFINITION
• Pressure exerted by fluids such as cerebrospinal fluid within skull on
the brain tissue.
FLOW OF CSF WITHIN THE BRAIN
• CSF is a clear fluid found in the subarachnoid spaces.
• The ventricles cushions the brain and spinal cord.
• It is secreted by the choroid plexus in the lateral ventricles
• Travels to the third ventricle via the foramen of Monroe.
• From the third ventricle, CSF reaches the fourth ventricle through the
aqueduct of Sylvius.
• From here, it flows into the subarachnoid space via the foramina of
Magendie and Luschka
• It is eventually reabsorbed into the dural venous sinuses by arachnoid
granulation.
ETIOLOGY
• The causes of increased intracranial pressure (ICP) can be divided
based on the intracerebral components causing elevated pressures:
• Increase in brain volume
• Generalized swelling of the brain or cerebral edema from a variety of
causes such as trauma, ischemia, hyperammonemia, uremic
encephalopathy, and hyponatremia
ETIOLOGY
Include:
• mass effect
• Increase in Cerebrospinal Fluid
• Decreased Reabsorption of CSF
• Increase in Blood Volume
• Other Causes
• Mass Effect
• Hematoma
• Tumor
• Abscess
• Infarct
• Increase in Cerebrospinal Fluid
• Increased production of CSF
• Choroid plexus tumor
• Decreased Reabsorption of CSF
• Obstructive hydrocephalus
• Meningeal inflammation or granulomas
• Increase in Cerebrospinal Fluid
• Increased production of CSF
• Choroid plexus tumor
• Decreased Reabsorption of CSF
• Obstructive hydrocephalus
• Meningeal inflammation or granulomas
Increase in Blood Volume
• Increased cerebral blood flow during hypercarbia, aneurysms
• Venous stasis from
• Venous sinus thromboses,
• Elevated central venous pressures, e.g., heart failure
• Other Causes
• Idiopathic or benign intracranial hypertension
• Skull deformities such as craniosynostosis
• Hypervitaminosis A, tetracycline use
PATHOPHYSIOLOGY
• Cerebral perfusion pressure(CPP), the pressure of blood
flowing to the brain. It is normally fairly constant due to
autoregulation.
• Abnormal mean arterial pressure (MAP) or abnormal ICP the
cerebral perfusion pressure is calculated by subtracting the
intracranial pressure from the mean arterial
pressure: CPP = MAP − ICP
PATHOPHYSIOLOGY
• Cerebral perfusion pressure (CPP), the pressure of blood
flowing to the brain. It is normally fairly constant due to
autoregulation.
PATHOPHYSIOLOGY
• The total volumes of the brain tissues, cerebrospinal fluid (CSF), and
intracranial blood are fixed.
• An increase in the volume of one component will result in a decrease
in volume in one or two of the other components.
• The clinical implication of the change in volume of the component is a
decrease in cerebral blood flow or herniation of the brain.
