![]() ![]() Herniation of different brain structures leads to different clinical features. Herniation can be defined as the movement of brain structures from one cranial compartment to another. If CPP drops too low for a significant amount of time, ischaemia occurs. CPP can be calculated using the equation below:Ī rise in ICP will reduce CPP. Cushing’s triad Cerebral Perfusion Pressure (CPP)Ĭerebral perfusion pressure is the pressure driving blood through the brain tissue, allowing the delivery of oxygen and nutrients. It leads to a triad of hypertension, bradycardia, and an irregular breathing pattern (Figure 3). ![]() Abnormal posturing, initially decorticate and then decerebrateĬushing’s reflex is a physiological response to raised ICP which attempts to improve perfusion.Ipsilateral sluggish dilated pupil which then becomes fixed (“blown pupil”).Initially, this can be achieved through a process referred to as compliance.Īn increase in the amount of blood in the skull leads to a compensatory decrease in the amount of CSF and normal ICP is maintained (Figure 1).Ĭlinical features of raised ICP can include: If the volume of one of these substances increases, to maintain a constant ICP, the volume of one of the others must decrease. Within the skull there are three main substances: The skull is a closed rigid box with a fixed capacity (after the sutures have closed). The Monro-Kellie hypothesis describes the relationship between the contents of the skull and intracranial pressure (ICP). Head injuries are the most common cause of death and disability in those under the age of 40 in the UK. 1Īlthough the incidence of death from head injuries overall is low (0.2%), the consequences of missing major pathology can be catastrophic. ![]() Traumatic head injuries are a common presentation, with 1.4 million patients attending emergency departments in the United Kingdom every year. The severity of head injuries can vary from minor head injuries to life-threatening traumatic brain injury (TBI) and/or intracranial haemorrhage. You may also be interested in our overview of the ABCDE approach and other emergency management guides. ![]()
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