Intracranial Pressure Monitoring

ICP elevation can infer the presence of cerebral edema. Symptoms of elevated ICP include headache, nausea, vomiting, and altered level of consciousness, which may be superimposed on focal neurologic deficits. When ICP reaches a critical threshold, herniation syndromes may ensue. The initial presentation of this clinical scenario demands an emergent CT scan of the head to identify the underlying process and assess the degree of parenchymal injury. Although neuroimaging methods routinely diagnose the presence of cerebral edema, ICP monitoring devices may detect the evolution of edema in patients expected to develop this complication. A diagnostic lumbar puncture may be performed safely on most patients whose imaging does not indicate a mass lesion to identify elevations of CSF pressure. ICP monitoring by ventriculostomy can be employed to permit drainage of CSF in hydrocephalic conditions. Continuous ICP monitoring is also possible with subarachnoid bolts, fiberoptic catheters, and subdural and epidural devices. These instruments may reflect focal pressure fluctuations and thus may not correlate with global changes in ICP. The utility of additional diagnostic measures such as electro ence-phalograph, transcranial Doppler ultrasonography, and somatosensory-evoked potential monitoring currently remains under investigation.

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