General Aspects

Intracranial pressure (ICP), the pressure of the CSF, remains within physiologic range (90 to 180 mm H2O) as long as the volume of the brain, circulating blood, and CSF remain constant. An increase in brain volume initially is compensated for by a decrease in blood flow and CSF volume. When the edema persists and progresses, however, this compensatory mechanism fails; subsequently, the intracranial pressure rises. When it exceeds 200 mm H2O, clinical symptoms develop: headache, nausea, vomiting, altered mentation, visual impairment, and papilledema. A computed tomography (CT) scan readily reveals the edema, showing obliteration of the sulci and cisterns, hypodensity of the white matter with fingerlike projections, and compression of the ventricles.

As the brain volume continues to increase, hippo-campal and cerebellar tonsillar herniations with brain-stem and medullary compressions occur. When the intracranial pressure reaches the level of the systemic blood pressure, the circulation ceases and death occurs.

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