Introduction

• Uncontrollable ICP remains a frequent cause of death in severely

head-injured patient.
• Intracranial hypertension is a problem in at least half of the patients
with mass lesions and in one-third of patients with diffuse injury.
CSF
• Actually the origin of CSF is remain unclear, two sites of formation are
known to exist; choroid plexus and the ventricular ependyma.
• Normal rates of CSF formation in man have been estimated to equal
0,35ml/min or approximately 500 ml/day.

Absorption
- CSF absorption takes place at the arachnoid villi, where the CSF is
returned to the blood via the dural sinus
Circulation
What parameter are likely to contribute to
raised ICP?
At least there are three parameters:
• Rate of formation
• Resistance to outflow of fluid (absorption)
• Elevation in dural sinus pressure

When the CSF volume altered, the CSF pressure will change, and the
amount of pressure change will depend on the three factors; the rate of
volume change, the amount of volume change and the intracranial
compliance
Measurement of Brain Compliance
It can be measured by injecting small quantities of fluid into the CSF
space and recording the instantaneous rise in ICP.

There also 2 conditions are necessary to obtaining the pressure volume

curve; 1st, the rate of volume addition must be considerably higher than
the rate of formation; 2nd , the magnitude of volume addition must not
exceed that level which cause vasodilation or alteration of the original
pressure
Lumbar-Ventricular Perfusion
In this method which also known as constant pressure infusion technique
and is carried out by introducing a constant rate infusion with an overfow
cannulae through a ventricular catheter.

CSF absorption is calculated as the difference between the infusion rate

and outflow rate.

Vin: the infused CSF volume; qf: CSF formation rate; Vout: CSF collected via
ventricular catheter
Effect of ICP and Hypotension in Head Injury
on Outcome
• High ICP → poor outcome and mortality if not treated well.

Previous studies showed that relatively small numbers of patients and

multiplicity of other factors involved.
Another large scale of ICP study by Traumatic Coma Data Bank (TCDB)
(1030 px, got 428 px met with the criteria for research) concluded that age
at admission, motor score, abnormal pupils were highly significant in
explaining outcome