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Review
. 2020 Jun 23;17(1):40.
doi: 10.1186/s12987-020-00201-8.

Review: pathophysiology of intracranial hypertension and noninvasive intracranial pressure monitoring

Nicolas Canac  1 , Kian Jalaleddini  2 , Samuel G Thorpe  2 , Corey M Thibeault  2 , Robert B Hamilton  2
Affiliations
Review

Review: pathophysiology of intracranial hypertension and noninvasive intracranial pressure monitoring

Nicolas Canac et al. Fluids Barriers CNS. .

Abstract

Measurement of intracranial pressure (ICP) is crucial in the management of many neurological conditions. However, due to the invasiveness, high cost, and required expertise of available ICP monitoring techniques, many patients who could benefit from ICP monitoring do not receive it. As a result, there has been a substantial effort to explore and develop novel noninvasive ICP monitoring techniques to improve the overall clinical care of patients who may be suffering from ICP disorders. This review attempts to summarize the general pathophysiology of ICP, discuss the importance and current state of ICP monitoring, and describe the many methods that have been proposed for noninvasive ICP monitoring. These noninvasive methods can be broken down into four major categories: fluid dynamic, otic, ophthalmic, and electrophysiologic. Each category is discussed in detail along with its associated techniques and their advantages, disadvantages, and reported accuracy. A particular emphasis in this review will be dedicated to methods based on the use of transcranial Doppler ultrasound. At present, it appears that the available noninvasive methods are either not sufficiently accurate, reliable, or robust enough for widespread clinical adoption or require additional independent validation. However, several methods appear promising and through additional study and clinical validation, could eventually make their way into clinical practice.

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Conflict of interest statement

At the time this review was conducted, all authors were employees of and either hold stock or stock options in Neural Analytics, Inc.

Figures

Fig. 1
Fig. 1
An ICP pulse waveform, with three characteristic peaks: P1, P2, and P3
Fig. 2
Fig. 2
The relationship between pressure and volume within the intracranial compartment. In region A, changes in the volume of one intracranial component can be buffered by changes in the volume of other components, resulting in minimal change in ICP. In region B, this buffering capacity is becoming exhausted, and ICP, though still within a normal range, begins to rise. Finally, in region C, the buffering capacity has been completely exhausted, and ICP rises rapidly at an accelerating rate in response to an increase in one or more intracranial components
Fig. 3
Fig. 3
CBFV pulse waveform. Systolic, diastolic, and mean flow velocity are used to calculate PI
See this image and copyright information in PMC

References

    1. Kumar G, Kalita J, Misra UK. Raised intracranial pressure in acute viral encephalitis. Clin Neurol Neurosurg. 2009;111(5):399–406. - PubMed
    1. Thomale UW, Graetz D, Vajkoczy P, Sarrafzadeh AS. Severe traumatic brain injury in children-a single center experience regarding therapy and long-term outcome. Child’s nervous system. 2010;26(11):1563–1573. - PubMed
    1. Czosnyka M, Pickard JD. Monitoring and interpretation of intracranial pressure. J Neurol Neurosurg Psychiatry. 2004;75(6):813–821. - PMC - PubMed
    1. Treggiari MM, Schutz N, Yanez ND, Romand JA. Role of intracranial pressure values and patterns in predicting outcome in traumatic brain injury: a systematic review. Neurocrit Care. 2007;6(2):104–112. - PubMed
    1. Helbok R, Olson DM, Le Roux PD, Vespa P, et al. Intracranial pressure and cerebral perfusion pressure monitoring in non-TBI patients: special considerations. Neurocrit Care. 2014;21(2):85–94. - PubMed

MeSH terms