Management of Increased Intracranial Pressure

Abstract

This chapter discusses the intracranial pressure (ICP) in the growing child and young adult. The purpose is to give the reader a condensed view of possible causes, symptoms, and the basal initial management in general and at different ages in the child with a pathological high intracranial pressure. Keywords IntroductionThe intracranial pressure (ICP) is dependent on three compartments inside the fi xed volume of the cranium: volumes of the brain, blood, and cerebrospinal fl uid (CSF), respectively. Brain tissue occupies about 80 % of the total intracranial volume. The remaining 20 % are evenly shared by blood (in arteries and veins) and CSF (in the ventricles, the basal cisterns, and the subarachnoid space). Since these volumes are not compressible, ICP is normally measured by assuming that it is evenly distributed among all intracranial compartments, including the intradural space of the spinal canal. This also assumes that the CSF circulation is constant without any obstruction.The normal intracranial pressure increases with age (Table 12.1 ), partly because the cranial bones that cover the brain will be more rigid as the fontanels and the sutures close with age. As the child gets older, the calvarial bone and meninges increase in size as the brain matures; also the volumes of blood and cerebrospinal fl uid (CSF) increase as the child grows. After the fontanels are closed, the intracranial volume becomes constant. This means that if one intracranial component increases in volume, it can be compensated by a decreased volume in one or both of