Intraventricular pressure in the final stages of a severe brain injury

Summary

Between 1964 and 1970, inclusive, 250 intraventricular pressure recordings were performed in the Neurosurgical Clinic of the Helsinki University Central Hospital. 95 of these patients had severe brain injuries. Of these, 17 patients died while the recording was in progress, and these patients form the series analysed here. In five instances the intraventricular pressure fluctuated considerably, and no pattern could be established. In the remaining 12, before respiratory arrest, there was a rise in pressure, usually above 100 mmHg, after which the pressure would drop 5–90 minutes later; respiratory arrest sometimes occurred at about the same time as the sudden rise in pressure, sometimes more than an hour later.

It is suggested that this rise and subsequent drop to a level only 10–20 mmHg lower than the blood pressure indicates the death of the supratentorial part of the brain; this, of course, means that any subsequent therapeutic efforts are exclusively for medico-legal or for transplantation purposes.

From experience with two patients, it is suggested that death of the brain is accompanied by a sharp drop in pH_csf.