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Increased Intracranial Pressure in Critically Ill Cancer Patients

  • Abhi PandhiEmail author
  • Rashi Krishnan
  • Nitin Goyal
  • Marc Malkoff
Living reference work entry

Abstract

Raised ICP can be seen with varied pathologies including traumatic brain injury (TBI), emergent large vessel occlusion stroke (ELVO), intracranial hemorrhage (ICH), primary versus metastatic neoplasms, diffuse brain processes such as cerebral edema, hepatic failure, inflammation and infection, hydrocephalus, and idiopathic.

ICP can be measured via an external ventricular drain (EVD) or a parenchymal bolt. Early clinical signs include headache, papilledema, nausea, stupor, and coma. Early recognition is helpful for early management to prevent cerebral hypoperfusion and brain death.

Management involves multiple tiers of therapies including head of bed up, sedation and analgesia, neuromuscular blockage, mild hyperventilation, and osmotherapy followed by barbiturate coma, therapeutic hypothermia, and aggressive hyperventilation. Last-ditch therapy involves decompressive hemicraniectomy. The use of multimodality monitoring helps in tailoring the appropriate therapy.

Keywords

Intracranial pressure Cerebral herniation Osmotherapy Craniectomy Indices indicated in green color 

References

  1. 1.
    Andrews PJ, Sinclair HL, Rodriguez A, Harris BA, Battison CG, Rhodes JK, Murray GD, Eurotherm3235 Trial Collaborators. Hypothermia for intracranial hypertension after traumatic brain injury. N Engl J Med. 2015;373(25):2403–12.  https://doi.org/10.1056/NEJMoa1507581.CrossRefPubMedGoogle Scholar
  2. 2.
    Bouzat P, et al. Accuracy of brain multimodal monitoring to detect cerebral hypoperfusion after traumatic brain injury. Crit Care Med. 2014;43(2):445–52.CrossRefGoogle Scholar
  3. 3.
    Bekar A, Goren S, Korfali E, Aksoy K, Boyaci S. Complications of brain tissue pressure monitoring with a fibreoptic device. Neurosurg Rev. 1998;21:254–9.CrossRefGoogle Scholar
  4. 4.
    Burns TC, Awad AJ, Li MD, Grant GA. Radiation-induced brain injury: low-hanging fruit for neuroregeneration. Neurosurg Focus. 2016;40(5):E3.  https://doi.org/10.3171/2016.2.FOCUS161.CrossRefPubMedGoogle Scholar
  5. 5.
    Carney N, Totten AM, O’Reilly C, Ullman JS, Hawryluk GW, Bell MJ, Ghajar J. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery. 2017;80(1):6–15.  https://doi.org/10.1227/NEU.01432.CrossRefPubMedGoogle Scholar
  6. 6.
    Chesnut RM, Temkin N, Carney N, et al. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med. 2012;367(26):2471–81.  https://doi.org/10.1056/NEJMoa1207363.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2012;43(6):1711–37.  https://doi.org/10.1161/STR.0b013e3182587839.CrossRefPubMedGoogle Scholar
  8. 8.
    Cooper DJ, Rosenfeld JV, Murray L, Arabi YM, Davies AR, D’Urso P, New Zealand intensive care society clinical trials, G, et al. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med. 2011;364(16):1493–502.  https://doi.org/10.1056/NEJMoa1102077.CrossRefPubMedGoogle Scholar
  9. 9.
    Cryer HG, Manley GT, Adelson PD, Alali AS, Calland JF, Cipolle M, Wright DW. ACS TQIP best practices in the management of traumatic brain injury. Chicago: American College of Surgeons; 2015.Google Scholar
  10. 10.
    Czosnyka M, Kirkpatrick PJ, Pickard JD. Multimodal monitoring and assessment of cerebral haemodynamic reserve after severe head injury. Cerebrovasc Brain Metab Rev. 1996;8(4):273–95.PubMedGoogle Scholar
  11. 11.
    Czosnyka M, Czosnyka Z, Pickard JD. Laboratory testing of the Spiegelberg brain pressure monitor: a technical report. J Neurol Neurosurg Psychiatry. 1997;63:732–5.CrossRefGoogle Scholar
  12. 12.
    Eriksson EA, et al. Cerebral perfusion pressure and intracranial pressure are not surrogates for brain tissue oxygenation in traumatic brain injury. Clin Neurophysiol. 2012;123:1255–60.CrossRefGoogle Scholar
  13. 13.
    Freeman WD. Management of intracranial pressure. Continuum (Minneap Minn). 2015;21(5 Neurocritical Care):1299–323.  https://doi.org/10.1212/CON.0235.CrossRefGoogle Scholar
  14. 14.
    Francony G, Fauvage B, Falcon D, et al. Equimolar doses of mannitol and hypertonic saline in the treatment of increased intracranial pressure. Crit Care Med. 2008;36(3):795–800.  https://doi.org/10.1097/CCM.0B013E3181643B41.CrossRefPubMedGoogle Scholar
  15. 15.
    Gaab MR, Heissler HE, Ehrhardt K. Physical characteristics of various methods for measuring ICP. In: Hoff JT, Betz AL, editors. Intracranial pressure VII. Berlin: Springer; 1989. p. 16–21.CrossRefGoogle Scholar
  16. 16.
    Hemphill JC 3rd, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, Fung GL, Goldstein JN, Macdonald RL, Mitchell PH, Scott PA, Selim MH, Woo D, American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46(7):2032–60.  https://doi.org/10.1161/STR.0000000000000069.CrossRefPubMedGoogle Scholar
  17. 17.
    Howells T, et al. Pressure reactivity as a guide in the treatment of cerebral perfusion pressure in patients with brain trauma. J Neurosurg. 2005;102(2):311–7.CrossRefGoogle Scholar
  18. 18.
    Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J, Collaborators, R. E. T, et al. Trial of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med. 2016;375(12):1119–30.  https://doi.org/10.1056/NEJMoa1605215.CrossRefPubMedGoogle Scholar
  19. 19.
    Jiang JY, Xu W, Li WP, et al. Effect of long-term mild hypothermia or short-term mild hypothermia on outcome of patients with severe traumatic brain injury. J Cereb Blood Flow Metab. 2006;26(6):771–6.  https://doi.org/10.1038/sj.jcbfm.9600253.CrossRefPubMedGoogle Scholar
  20. 20.
    Greenberg J. Handbook of head and spine trauma. 1993. p. 230–3.Google Scholar
  21. 21.
    Johnston AJ, et al. Effect of cerebral perfusion pressure augmentation on regional oxygenation and metabolism after head injury. Crit Care Med. 2005;33(1):189–95.CrossRefGoogle Scholar
  22. 22.
    Kaal EC, Vecht CJ. The management of brain edema in brain tumors. Curr Opin Oncol. 2004;16(6):593–600.CrossRefGoogle Scholar
  23. 23.
    Kahraman S, et al. Heart rate and pulse pressure variability are associated with intractable intracranial hypertension after severe traumatic brain injury. J Neurosurg Anesthesiol. 2010;22(4):296–302.CrossRefGoogle Scholar
  24. 24.
    Mostofi K. Neurosurgical management of massive cerebellar infarct outcome in 53 patients. Surg Neurol Int. 2013;4:28.  https://doi.org/10.4103/2152-7806.107906.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Khormi YH, Gosadi I, Campbell S, Senthilselvan A, O’Kelly C, Zygun D. Adherence to brain trauma foundation guidelines for management of traumatic brain injury patients and its effect on outcomes: systematic review. J Neurotrauma. 2018;  https://doi.org/10.1089/neu.2017.5345.CrossRefGoogle Scholar
  26. 26.
    Langfitt TW, Weinstein JD, Kassell NF, Simeone FA. Transmission of increased intracranial pressure I: within the craniospinal axis. J Neurosurg. 1964;21: 989–97.CrossRefGoogle Scholar
  27. 27.
    Lazaridis C, et al. Patient-specific thresholds of intracranial pressure in severe traumatic brain injury. J Neurosurg. 2014;120(4):893–900.CrossRefGoogle Scholar
  28. 28.
    Lewandowski-Belfer JJ, Patel AV, Darracott RM, et al. Safety and efficacy of repeated doses of 14.6 or 23.4% hypertonic saline for refractory intracranial hypertension. Neurocrit Care. 2014;20(3):436–42.  https://doi.org/10.1007/s12028Y013Y9907Y1.CrossRefPubMedGoogle Scholar
  29. 29.
    Lou M, Xue F, Chen L, Xue Y, Wang K. Is high PEEP ventilation strategy safe for acute respiratory distress syndrome after severe traumatic brain injury? Brain Inj. 2012;26(6):887–90.  https://doi.org/10.3109/02699052.2012.660514.CrossRefPubMedGoogle Scholar
  30. 30.
    Lundberg N. Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiat Neurol Scand. 1960;36(suppl):149.Google Scholar
  31. 31.
    Lundberg N, Troupp H, Lorin H. Continuous recording of the ventricular fluid pressure in patients with severe acute traumatic brain injury. J Neurosurg. 1965;22: 581–90.CrossRefGoogle Scholar
  32. 32.
    Mack WJ, King RG, Ducruet AF, Kreiter K, Mocco J, Maghoub A, Mayer S, Connolly ES Jr. Intracranial pressure following aneurysmal subarachnoid hemorrhage: monitoring practices and outcome data. Neurosurg Focus. 2003;14:1–5.CrossRefGoogle Scholar
  33. 33.
    Maloney-Wilensky E, et al. Brain tissue oxygen and outcome after severe traumatic brain injury: a systematic review. Crit Care Med. 2009;37:2057–63.CrossRefGoogle Scholar
  34. 34.
    Marion DW. Controlled normothermia in neurologic intensive care. Crit Care Med. 2004;32(2 suppl):S43–5.  https://doi.org/10.1097/01.CCM.0000110731.69637.16.CrossRefPubMedGoogle Scholar
  35. 35.
    May K. The pathophysiology and causes of raised intracranial pressure. Br J Nurs. 2009;18(15):911–4.CrossRefGoogle Scholar
  36. 36.
    McCafferty R, et al. Joint trauma system clinical practice guideline: neurosurgery and severe head injury (CPG ID:30). 2017.Google Scholar
  37. 37.
    McCauley SR, Wilde EA, Moretti P, et al. Neurological outcome scale for traumatic brain injury: III. Criterion-related validity and sensitivity to change in the NABIS hypothermia-II clinical trial. J Neurotrauma. 2013;30(17):1506–11.  https://doi.org/10.1089/neu.2013.2925.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Macdonald DR, Cairncross JG. Surgery for single brain metastasis. N Engl J Med. 1990;323(2):132–3.CrossRefGoogle Scholar
  39. 39.
    Menon DK, et al. Diffusion limited oxygen delivery following head injury. Crit Care Med. 2004;32: 1384–90.CrossRefGoogle Scholar
  40. 40.
    Miller JD. Measuring ICP in patients: its value now and in the future. In: Hoff JT, Betz AL, editors. Intracranial pressure VII. Berlin/Heidelberg/New York: Springer; 1989. p. 5–15.CrossRefGoogle Scholar
  41. 41.
    Monro A. Observations on the structure and function of the nervous system. Edinburgh: Creech & Johnson; 1783.Google Scholar
  42. 42.
    Muizelaar JP, Marmarou A, Ward JD, et al. Adverse effects of prolonged hyperventilation in patients with severe head injury: a randomized clinical trial. J Neurosurg. 1991;75(5):731–9.CrossRefGoogle Scholar
  43. 43.
    Oddo M, et al. Brain hypoxia is associated with short-term outcome after severe traumatic brain injury independently of intracranial hypertension and low cerebral perfusion pressure. Neurosurgery. 2011;69:1037–45.PubMedGoogle Scholar
  44. 44.
    Oddo M, et al. Anemia and brain oxygen after severe traumatic brain injury. Intensive Care Med. 2012;38:1497–504.CrossRefGoogle Scholar
  45. 45.
    Okonkwo DO, Shutter LA, Moore C, Temkin NR, Puccio AM, Madden CJ, Andaluz N, Chesnut RM, Bullock MR, Grant GA, McGregor J, Weaver M, Jallo J, LeRoux PD, Moberg D, Barber J, Lazaridis C, Diaz-Arrastia RR. Brain oxygen optimization in severe traumatic brain injury phase-II: a phase II randomized trial. Crit Care Med. 2017;45(11):1907–14.  https://doi.org/10.1097/CCM.02619.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Peace K, Wilensky EM, Frangos S, et al. The use of a portable head CT scanner in the intensive care unit. J Neurosci Nurs. 2010;42(2):109–16.  https://doi.org/10.1097/JNN.0b013e3181ce5c5b.CrossRefPubMedGoogle Scholar
  47. 47.
    Peace K, Maloney-Wilensky E, Frangos S, et al. Portable head CT scan and its effect on intracranial pressure, cerebral perfusion pressure, and brain oxygen. J Neurosurg. 2011;114(5):1479–84.  https://doi.org/10.3171/2010.11.JNS091148.CrossRefPubMedGoogle Scholar
  48. 48.
    Pandhi A, Elijovich L. Postoperative positioning in the neurointensive care unit. In: Arthur A, Foley K, Hamm C, editors. Perioperative considerations and positioning for neurosurgical procedures. Cham: Springer; 2018.  https://doi.org/10.1007/978-3-319-72679-3_19.CrossRefGoogle Scholar
  49. 49.
    Pandit L, Agrawal A. Neuromuscular disorders in critical illness. Clin Neurol Neurosurg. 2006;108(7): 621–7.CrossRefGoogle Scholar
  50. 50.
    Ponce LL, et al. Position of probe determines prognostic information of brain tissue pO2 in severe traumatic brain injury. Neurosurgery. 2012;70(6):1492–502.CrossRefGoogle Scholar
  51. 51.
    Raabe A, Totzauer R, Meyer O, Stockel R, Hohrein D, Schoeche J. Reliability of extradural pressure measurement in clinical practice: behaviour of three modern sensors during simultaneous ipsilateral intraventricular or intraparenchymal pressure measurement. Neurosurgery. 1998;43:306–11.CrossRefGoogle Scholar
  52. 52.
    Rangel-Castilla L1, Gopinath S, Robertson CS. Management of intracranial hypertension. Neurol Clin. 2008;26(2):521–41.  https://doi.org/10.1016/j.ncl.2008.02.003.CrossRefPubMedGoogle Scholar
  53. 53.
    Rengachary SS, Ellenbogen RG, editors. Principles of neurosurgery. Edinburgh: Elsevier Mosby; 2005.Google Scholar
  54. 54.
    Reynolds SF, Heffner J. Airway management of the critically ill patient: rapid-sequence intubation. Chest. 2005;127(4):1397–412.  https://doi.org/10.1378/chest.127.4.1397.CrossRefPubMedGoogle Scholar
  55. 55.
    Roberts I, Yates D, Sandercock P, et al. Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): randomized placebo-controlled trial. Lancet. 2004;364(9442):1321–8.  https://doi.org/10.1186/cc3813.CrossRefPubMedGoogle Scholar
  56. 56.
    Rose JC, Mayer SA. Optimizing blood pressure in neurological emergencies. Neurocrit Care. 2004;1(3):287–99.CrossRefGoogle Scholar
  57. 57.
    Ryken TC, McDermott M, Robinson PD, et al. The role of steroids in the management of brain metastases: a systematic review and evidence-based clinical practice guideline. J Neuro-Oncol. 2010;96(1):103–14.  https://doi.org/10.1007/s11060Y009Y0057Y4.CrossRefGoogle Scholar
  58. 58.
    Sen AP, Gulati A. Use of magnesium in traumatic brain injury. Neurotherapeutics. 2010;7(1):91–9.  https://doi.org/10.1016/j.nurt.2009.10.014.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Shenkin HA. Steroids in treatment of high intracranial pressure. N Engl J Med. 1970;283(12):659.PubMedGoogle Scholar
  60. 60.
    Singh IN, et al. Time course of post-traumatic mitochondrial oxidative damage and dysfunction in a mouse model of focal traumatic brain injury: implications for neuroprotective therapy. J Cereb Blood Flow Metab. 2006;26:1407–18.CrossRefGoogle Scholar
  61. 61.
    Stocchetti N, Picetti E, Berardino M, et al. Clinical applications of intracranial pressure monitoring in traumatic brain injury: report of the Milan consensus conference. Acta Neurochir. 2014;156(8):1615–22.  https://doi.org/10.1007/s00701Y014Y2127Y4.CrossRefPubMedGoogle Scholar
  62. 62.
    Temkin NR, Anderson GD, Winn HR, et al. Magnesium sulfate for neuroprotection after traumatic brain injury: a randomised controlled trial. Lancet Neurol. 2007;6:29–38.CrossRefGoogle Scholar
  63. 63.
    The Brain Trauma Foundation, The American Association of Neurological Surgeons, The Joint Section on Neurotrauma and Critical Care. Recommendations for intracranial pressure monitoring technology. J Neurotrauma. 2000;17:497–506.CrossRefGoogle Scholar
  64. 64.
    The Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care, AANS/CNS, Bratton SL, Chestnut RM, Ghajar J, et al. Guidelines for the management of severe traumatic brain injury. VII. Intracranial pressure monitoring technology. J Neurotrauma. 2007;24(suppl 1):S45–54.Google Scholar
  65. 65.
    Timofeev I, et al. Cerebral extracellular chemistry and outcome following traumatic brain injury: a microdialysis study of 223 patients. Brain. 2011;134: 484–94.CrossRefGoogle Scholar
  66. 66.
    Vasung L, Hamard M, Soto MCA, Sommaruga S, Sveikata L, Leemann B, Vargas MI. Radiological signs of the syndrome of the trephined. Neuroradiology. 2016;58(6):557–68.  https://doi.org/10.1007/s00234-016-1651-8.CrossRefPubMedGoogle Scholar
  67. 67.
    Vespa P, et al. Metabolic crisis without brain ischemia is common after traumatic brain injury: a combined microdialysis and positron emission tomography study. J Cereb Blood Flow Metab. 2005;25:763–74.CrossRefGoogle Scholar
  68. 68.
    Vik A, et al. Relationship of “dose” of intracranial hypertension to outcome in severe traumatic brain injury. J Neurosurg. 2008;109(4):678–84.CrossRefGoogle Scholar
  69. 69.
    Wu OC, Manjila S, Malakooti N, Cohen AR. The remarkable medical lineage of the Monro family: contributions of Alexander primus, secundus, and tertius. J Neurosurg. 2012;116(6):1337–46.  https://doi.org/10.3171/2012.2.JNS111366.CrossRefPubMedGoogle Scholar
  70. 70.
    Zhang D, Xue Q, Chen J, Dong Y, Hou L, Jiang Y, Wang J. Decompressive craniectomy in the management of intracranial hypertension after traumatic brain injury: a systematic review and meta-analysis. Sci Rep. 2017;7(1):8800.  https://doi.org/10.1038/s41598-017-08959-y.CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Zweifel C, Dias C, Smielewski P, Czosnyka M. Continuous time-domain monitoring of cerebral autoregulation in neurocritical care. Med Eng Phys. 2014;36(5):638–45.  https://doi.org/10.1016/j.medengphy.2014.03.002.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Abhi Pandhi
    • 1
    Email author
  • Rashi Krishnan
    • 1
  • Nitin Goyal
    • 1
  • Marc Malkoff
    • 1
  1. 1.Department of NeurologyUniversity of Tennessee Health Science CenterMemphisUSA

Section editors and affiliations

  • Yenny Cardenas
    • 1
  1. 1.Critical Care DepartmentUniversidad del Rosario Hospital Universitario Fundacion Santa Fe deBogotaColombia

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