
Contents
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Chapter contents Chapter contents
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Intracranial pressure monitoring Intracranial pressure monitoring
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Introduction Introduction
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Indications for ICP monitoring Indications for ICP monitoring
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Methods of measuring ICP Methods of measuring ICP
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Intraparenchymal monitors Intraparenchymal monitors
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Intraventricular catheters Intraventricular catheters
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Complications of ICP monitoring Complications of ICP monitoring
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ICP in normal and pathological conditions ICP in normal and pathological conditions
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Further reading Further reading
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Intracranial perfusion Intracranial perfusion
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Introduction Introduction
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Regulation of cerebral perfusion Regulation of cerebral perfusion
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Autoregulation (myogenic regulation) Autoregulation (myogenic regulation)
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Flow–metabolism coupling Flow–metabolism coupling
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Systemic factors Systemic factors
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Carbon dioxide Carbon dioxide
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Oxygen Oxygen
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Temperature Temperature
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Anaesthetic agents Anaesthetic agents
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Measurement of CBF Measurement of CBF
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Transcranial Doppler sonography Transcranial Doppler sonography
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Jugular venous bulb oximetry Jugular venous bulb oximetry
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Radiological techniques Radiological techniques
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Further reading Further reading
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EEG and CFAM monitoring EEG and CFAM monitoring
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Electroencephalogram Electroencephalogram
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CFM/CFAM CFM/CFAM
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EEG terminology EEG terminology
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Clinical use in ICU Clinical use in ICU
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Seizures and pseudoseizures Seizures and pseudoseizures
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Diagnosis of specific neurological conditions Diagnosis of specific neurological conditions
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Raised ICP Raised ICP
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Prognosis Prognosis
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Further reading Further reading
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Other forms of neurological monitoring Other forms of neurological monitoring
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Tissue metabolism Tissue metabolism
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Brain tissue oxygenation Brain tissue oxygenation
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Microdialysis Microdialysis
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Cerebral blood flow and metabolism Cerebral blood flow and metabolism
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NIRS NIRS
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Laser Doppler flowmetry Laser Doppler flowmetry
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Thermal diffusion flowmetry Thermal diffusion flowmetry
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Peripheral nerve and muscle electrophysiology Peripheral nerve and muscle electrophysiology
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Sensory evoked potentials (SEPs) Sensory evoked potentials (SEPs)
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Nerve conduction studies Nerve conduction studies
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Electromyography (EMG) Electromyography (EMG)
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Further reading Further reading
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Cite
Extract
Chapter contents
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Intracranial pressure monitoring
Introduction
In adults, the normal resting intracranial pressure (ICP) is 0–10mm Hg. ICP may rise to 50mm Hg or so during straining or sneezing, with no impairment in function. It is not, therefore, ICP alone that is important but rather the interpretation of the measurement in pathological conditions. Many of the clinicopathological changes associated with brain injury are the result of pressure differences between the intracranial compartments, with consequent shift of brain structures, rather than the absolute level of ICP.
The deterioration in conscious level accompanying elevation in ICP is probably caused by downward displacement of the diencephalon and midbrain structures. Herniation of the temporal lobe between the brainstem and the tentorial edge into the posterior fossa (tentorial or uncal herniation) causes pupillary dilatation, ptosis, limitation of upgaze and extensor posturing. Tonsillar herniation occurs when the tonsils of the cerebellum herniate through the foramen magnum into the spinal canal. This causes compression of the midbrain with changes in blood pressure, pulse rate and respiratory pattern. Cushing's response, the combination of hypertension and bradycardia, is seen in roughly 1/3 of cases of tonsillar herniation.
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