Diagnosis and management of elevated intracranial pressure in the emergency department

Abstract

Background: Elevated intracranial pressure is a devastating complication of catastrophic brain injury. Intracranial hypertension is commonly seen in neurologic injury secondary to traumatic brain injuries. Uncontrolled pressures can lead to permanent neurologic damage, but acute medical management is often overlooked when pursuing surgical management options that may not always be indicated.

Discussion: Traumatic brain injury is the leading cause of death in patients with severe neurologic injury. Diagnosing elevated intracranial pressures is imperative in initiating prompt treatment to reduce secondary central nervous system injury, morbidity, and mortality. Although the initial injury to the brain is typically irreversible, intracranial pressure control can assist in salvaging the remaining brain tissue from additional damage. We will discuss the initial medical and surgical management of traumatic brain injury to prevent further neurologic deterioration and reduce mortality.

Conclusion: Recent literature has reported several methods to detect elevated intracranial pressure easily and studies describing multiple treatment modalities. These investigations suggest that early detection and timely treatment of intracranial hypertension are beneficial in reducing mortality.

Keywords: Elevated intracranial pressure; Emergency department; Intracranial hypertension; Intracranial pressure; Traumatic brain injury.

Fig. 1

ICP pulse waveform represented by three peaks (P1, P2, P3)

Fig. 2

Emergency neurologic life support intracranial hypertension and herniation algorithm