**When ICP increases to the point where
INCREASED the brain’s ability to adjust has reached its
INTRACRANIAL
PRESSURE (IICP)
Intracranial Pressure (ICP)
• pressure in the skull that results
from the volume of 3 essential
components:
1. CSF, 75ml
2. BLOOD VOLUME, 75ml
3. CNS TISSUE, 1400g
o Normal ICP is between 8-
15mmHg.
3 components maintain a state of
equilibrium.
o The intact cranium cannot be
expanded
• Monro-Kellie hypothesis: because of a
limited space for expansion within
the skull, an increase in any one of
the components causes a change in
the volume of the others.
✔ Any increase in one of the
elements must be balanced
or compensated by a
proportional constriction
either or both of the other
components
• A syndrome characterized by
increase in the amount of CNS
tissue, CSF fluid or blood leading to
an ICP greater than 15mmHg.
• Once ICP reaches around 25mmHg
marked elevation in ICP will be
noted.
Increased ICP can impede the circulation to
the brain, stimulates further swelling,
impede the absorption of CSF, affect the
functioning of nerve cells, & lead to
brainstem compression & death
May shift brain tissue, resulting in
herniation, a frequently fatal
event
• Clinical Manifestations
limits, neural function is impaired.
(changes in LOC)
✔ Lethargy - earliest sign- SLEEPY ✔
Sudden change in condition
✔ Pt. becomes stuporous & may react
only to loud auditory or painful
stimuli.
✔ When coma is profound, pupils are
dilated & fixed, respirations are
impaired----death.
✔ CUSHING’S TRIAD
▪ HYPERtension + Widening
Pulse Pressure- 40mmHg
and below ex. 180/140
▪ BRADYcardia
▪ BRADYpnea
• Assessments
• Headache
• Vomiting
• Diplopia (CN VI)
• Body temperature may be elevated
or subnormal
• Pupillary changes
• Papilledema- swelling of optic nerve
• Lateralizing sign- this is a
contralateral loss of motor function
due to decussation of motor fibers at
the level of medulla oblongata.
• Pupillary Changes:
▪ Ipsilateral pupil dilatation (CN
3 compression)
▪ Bilateral pupil dilatations
• Pupillary Changes
anisocoria
Unilateral pupil dilatation
• Brainstem function impairment
✔ Doll’s eye phenomena
 abnormal when present &
may occur as the client
begins to experience a
decrease in LOC. Occurs
when the client’s head is
moved from side to side &
the eye remain in a fixed
midline position
✔ Decortication
✔ Decerebration
DIAGNOSTICS
CT scan, MRI, cerebral angiogram, EEG,
Caloric test (oculovestibular response)
ICP monitoring device:
✔ Purpose: to identify increased
pressure early in its course, to
quantify the degree of elevation, to
initiate appropriate treatment, to
provide access to CSF for sampling
& drainage, to evaluate the
effectiveness of treatment
✔ 3 ways to measure ICP:
• Intraventricular catheter
most accurate
• Subarachnoid/Subdural
screw/bolt
• Epidural Sensor
• MEDICAL MANAGEMENT
**Increased ICP is a true emergency & must
be treated promptly.
Goals:
⮚ Invasive monitoring of ICP
⮚ Decreasing cerebral edema
⮚ Lowering the volume of CSF
⮚ Decreasing cerebral blood volume
while maintaining cerebral
perfusion
⮚ Pharmacologic therapy
⮚ Patient requires care in the critical
care unit.
• Craniotomy for space occupying
PHARMACOTHERAPY
• Diuretics (mannitol, lasix),
cerebral edema
• Anticonvulsants (valium, dilantin,
phenobarbital, tegretol)
• Antipyretics
• Muscle relaxants
• BP medication
• Corticosteroids - Decadron
(dexamethasone)
• Antacids/H2 receptors
• Anticoagulants
• Stool softener
• Intravenous fluids
• Electrolyte replacement
Note: Opiates & sedatives are
contraindicated to the client with IICP. -
induce cerebral hypoxia and
vasodilation
• Treatment & Collaborative
Management
• Adequate oxygenation/ Maintain
respiratory function
• Position: Semi-fowlers
• Protect patient from injury
• Avoid factors that increases ICP
(Nausea and vomiting, sneezing and
coughing, valsalva maneuver, over
suctioning, restraints, rectal
examination, enema, flexion of
waist, hip or neck)
• Control fever
• Monitor intake & output
• Limit fluid intake to 1200ml/day •
SURGICAL INTERVENTIONS
• Ventriculoperitoneal shunt
shunts CSF from the ventricles
into the peritoneum
 lesions and cerebral hematoma

• Complications

• Herniation

• Seizures

• Cognitive deficits

• Motor deficits

• Sensory deficits

• Coma

• Death