Neurology Book


Intracranial Pressure

Aka: Intracranial Pressure, CSF Pressure, CSF Opening Pressure, Cerebral Perfusion Pressure
  1. See Also
    1. Cerebrospinal Fluid
    2. Lumbar Puncture
    3. Cerebrospinal Fluid Examination
  2. Background
    1. Not affected by systemic Blood Pressure
    2. Sensitive to blood pCO2
      1. Hyperventilation lowers Intracranial Pressure
  3. Technique
    1. Counsel patient to try to relax
      1. Avoid Hyperventilation (lowers pressure)
      2. Avoid straining (raises pressure)
    2. Patient lies in lateral decubitus position
      1. Legs and neck should be in neutral position
      2. Opening pressure not accurate in sitting position
  4. Interpretation
    1. Unit Conversions
      1. cmH2O = 1.3 x mmHg
      2. cmH2O = mmH2O / 10
    2. Normal
      1. Adults and older children: 10 to 15 mmHg (13 to 20 cm H2O)
      2. Younger children: 3 to 7 mmHg (4 to 9 cm H2O)
      3. Term Infants: 1 to 6 mmHg (2 to 8 cm H2O)
      4. Rangel-Castillo (2008) Neurol Clin 26(2): 521-41 [PubMed]
    3. Modifying Factors that increase Intracranial Pressure
      1. With pulse: 1 to 4 mmHg (2 to 5 cm H2O)
      2. With respirations: 3 to 8 mmHg (4 to 10 cm H2O)
      3. With sitting upright (compared with lateral decubitus): 11.4 mmHg (14.8 cm H2O)
        1. Abualenain (2011) Acad Emerg Med 18(1): 244 [PubMed]
    4. Decreased: Intracranial Hypotension (Opening Pressure <60 mmH2O or <6 cmH2O, uncommon)
      1. Trauma with secondary Cerebrospinal Fluid Leak
      2. Recent Lumbar Puncture (Spinal Headache)
      3. Spontaneous, Idiopathic Intracranial Hypotension (associated with positional Headache)
    5. Increased: Intracranial Hypertension (Opening Pressure >250 mmH2O, >25 cm H2O)
      1. Mild if 20 to 30 mmHg (26 to 39 cmH2O)
      2. See Increased Intracranial Pressure Causes
  5. Calculation: Cerebral Perfusion Pressure (CPP)
    1. Cerebral Perfusion Pressure (CPP) = Mean Arterial Pressure (MAP) - Intracranial Pressure (ICP)
      1. Critical to maintain in Increased Intracranial Pressure in Trauma
      2. If continuous ICP monitoring, Arterial Line transducer should zeroed at the ear (kept at same height of head)
      3. Decreased Cerebral Perfusion Pressure risks brain ischemia
    2. Monroe-Kellie Hypothesis
      1. CSF volume (blood, brain, csf) remains constant
        1. When one volume increases (e.g. blood in Intracranial Hemorrhage), then another decreases (e.g. csf, brain)
      2. Typical volumes (total 1450 ml)
        1. Brain: 1300 ml
        2. CSF: 65 ml
        3. Blood: 110 ml
  6. References
    1. Kooiker in Roberts (1998) Procedures in ER, p. 1067-75
    2. Ravel (1995) Lab Medicine, Mosby, p. 294-9
    3. Tunkel in Mandell (2000) Infectious Disease, p. 974-8
    4. Seehusen (2003) Am Fam Physician 68:1103-8 [PubMed]

Cerebrospinal Fluid Pressure (C0007809)

Definition (CSP) manometric pressure of the cerebrospinal fluid as measured by lumbar, cerebroventricular, or cisternal puncture.
Definition (MSH) Manometric pressure of the CEREBROSPINAL FLUID as measured by lumbar, cerebroventricular, or cisternal puncture. Within the cranial cavity it is called INTRACRANIAL PRESSURE.
Concepts Clinical Attribute (T201)
MSH D015170
SnomedCT 167715003, 144942008, 144938005, 86189008, 281668000
English Cerebrospinal Fluid Pressure, Cerebrospinal Fluid Pressures, Fluid Pressure, Cerebrospinal, Fluid Pressures, Cerebrospinal, Pressure, Cerebrospinal Fluid, Pressures, Cerebrospinal Fluid, cerebrospinal fluid pressure, CSF - Cerebrospinal fluid pres, CSF pressure NOS, CSF pressure NOS (finding), CSF PRESSURE, PRESSURE CSF, CSF PRESSURES, PRESSURES CSF, Cerebrospinal fluid press obs, pressure csf, csf pressures, csf pressure, cerebrospinal fluid pressures, pressure cerebrospinal fluid, Cerebrospinal fluid pressure NOS, CSF pressure NOS (observable entity), Cerebrospinal fluid pressure NOS (finding), Cerebrospinal fluid pressure, CSF - Cerebrospinal fluid pressure, CSF pressure, Cerebrospinal fluid pressure observation, Cerebrospinal fluid pressure (observable entity), Cerebrospinal fluid pressure finding (finding), Cerebrospinal fluid pressure finding
Japanese CSF圧, CSFアツ, 脊髄液圧, 髄液圧, 脳脊髄液圧
Swedish Likvortryck
Czech mozkomíšní mok - tlak, Tlak mozkomíšním moku
Finnish Likvoripaine
French Pression du LCS, Pression du liquide céphalo-rachidien, Pression du liquide céphalorachidien, Pression du LCR, Pression du liquide cérébrospinal
Croatian Not Translated[Cerebrospinal Fluid Pressure]
Spanish hallazgo relacionado con la presión del líquido cefalorraquídeo, hallazgo relacionado con la presión del líquido cefalorraquídeo (hallazgo), hallazgo en la presión del líquido cefalorraquídeo (hallazgo), hallazgo en la presión del líquido cefalorraquídeo, presión del líquido cefalorraquídeo, SAI (entidad observable), CSF pressure NOS, presión del líquido cefalorraquídeo, SAI, presión del LCR, SAI, presión del líquido cefalorraquídeo, SAI (hallazgo), Presión del Líquido Cerebroespinal, presión de LCR, presión del líquido cefalorraquídeo (entidad observable), presión del líquido cefalorraquídeo, Presión del LCR, Presión del Líquido Cefalorraquídeo
Polish Ciśnienie płynu mózgowo-rdzeniowego
Hungarian Liquor nyomás
Italian Pressione del liquido cerebrospinale, Pressione del fluido cerebro-spinale, Pressione del fluido cerebrospinale
Norwegian Cerebrospinalvæsketrykk, Trykk i cerebrospinalvæske
Portuguese Pressão do Líquido Espinhal, Pressão do Líquido Cefalorraquiano, Pressão do LCR, Pressão do Líquido Cefalorraquidiano
Dutch CSV druk, Druk, liquor-, Liquordruk
German Liquordruck
Derived from the NIH UMLS (Unified Medical Language System)

Intracranial Pressure (C0021880)

Definition (MSH) Pressure within the cranial cavity. It is influenced by brain mass, the circulatory system, CSF dynamics, and skull rigidity.
Definition (CSP) pressure within the cranial cavity, influenced by brain mass, the circulatory system, cerebrospinal fluid dynamics, and skull rigidity.
Concepts Organ or Tissue Function (T042)
MSH D007427
SnomedCT 250844005
English Intracranial Pressure, Intracranial Pressures, Pressure, Intracranial, Pressure, Subarachnoid, Pressures, Intracranial, Pressures, Subarachnoid, Subarachnoid Pressure, Subarachnoid Pressures, intracranial pressure, intracranial pressures, pressure intracranial, Intracranial pressure, ICP - Intracranial pressure, Intracranial pressure (observable entity)
Swedish Intrakraniellt tryck
Czech intrakraniální tlak, nitrolební tlak, subarachnoidální tlak
Finnish Aivopaine
French Pression subarachnoïdienne, Pression sous-arachnoïdienne, Pression intracrânienne
Italian Pressione subaracnoidea, Pressione endocranica
Japanese 脳内圧, 脳圧, クモ膜下圧, くも膜下圧, 頭蓋内圧
Portuguese Pressão Subaracnóidea, Pressão Intracraniana
Polish Ciśnienie wewnątrzczaszkowe, Ciśnienie śródczaszkowe
Norwegian Intrakranielt trykk
Spanish presión intracraneal (entidad observable), presión intracraneal, Presión Subaracnoidea, Presión Intracraneal
German Intrakranieller Druck, Subarachnoidaler Druck
Dutch Druk, intracraniale, Intracraniale druk
Derived from the NIH UMLS (Unified Medical Language System)

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