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. 2023 Apr 10;27:137. doi: 10.1186/s13054-023-04427-4

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© The Author(s) 2023

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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Fig. 1 — Different phases of the compensatory system. In the first phase (a), compensatory system is effective during a mass expansion. ICP does not change in this early phase, being ICC and the compensatory system adjusted. In a second phase (b), the compensatory system starts to fail following more increase in the mass effect. CSF and veins outflow are starting to be overloaded, beginning brain deformation and ICC impairment. In a third phase (c), the compensatory system is completely exhausted, and brain deformation and loss of ICC are evident. ICP: intracranial pressure, ICC: intracranial compliance, CSF: cerebrospinal fluid. Adapted from Wykes et al. [31]