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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1993 Aug;56(8):845–858. doi: 10.1136/jnnp.56.8.845

Management of raised intracranial pressure.

J D Pickard 1, M Czosnyka 1
PMCID: PMC1015137  PMID: 8350099

Abstract

This review has been written at an unfortunate time. Novel questions are being asked of the old therapies and there is an abundance of new strategies both to lower ICP and protect the brain against cerebral ischaemia. In the United Kingdom, the problem is to ensure that appropriate patients continue to be referred to centres where clinical trials of high quality can be undertaken. One of the success stories of the past decade has been the decline in the number of road accidents as a result of seat belt legislation, improvements in car design and the drink/driving laws. Hence, fortunately there are fewer patients with head injuries to treat and it is even more important that patients are appropriately referred if studies to assess efficacy of the new strategies are not to be thwarted. The nihilistic concept that intensive investigation with ICP monitoring for patients with diffuse head injury or brain swelling following evacuation of a haematoma or a contusion has no proven beneficial effect on outcome, requires revision. A cocktail of therapies may be required that can be created only when patients are monitored in sufficient detail to reveal the mechanisms underlying their individual ICP problem. Ethical problems may arise over how aggressively therapy for intracranial hypertension should be pursued and for how long. There has always been the concern that cranial decompression or prolonged barbiturate coma may preserve patients but with unacceptably severe disability. Some patients may be salvaged from herniating with massive cerebral infarction with the use of osmotherapy but is the outcome acceptable? Similar considerations apply to some children with metabolic encephalopathies. Where such considerations have been scrutinised in patients with severe head injury, the whole spectrum of outcomes appears to be shifted so that the number of severe disabilities and persistent vegetative states are not increased. However, it is important to be sensitive to such issues based on experience of the particular cause of raised intracranial pressure in a given age group.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aaslid R., Markwalder T. M., Nornes H. Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg. 1982 Dec;57(6):769–774. doi: 10.3171/jns.1982.57.6.0769. [DOI] [PubMed] [Google Scholar]
  2. Aldrich E. F., Eisenberg H. M., Saydjari C., Luerssen T. G., Foulkes M. A., Jane J. A., Marshall L. F., Marmarou A., Young H. F. Diffuse brain swelling in severely head-injured children. A report from the NIH Traumatic Coma Data Bank. J Neurosurg. 1992 Mar;76(3):450–454. doi: 10.3171/jns.1992.76.3.0450. [DOI] [PubMed] [Google Scholar]
  3. Auer L. M., Haselsberger K. Effect of intravenous mannitol on cat pial arteries and veins during normal and elevated intracranial pressure. Neurosurgery. 1987 Aug;21(2):142–146. doi: 10.1227/00006123-198708000-00002. [DOI] [PubMed] [Google Scholar]
  4. Avezaat C. J., van Eijndhoven J. H., Wyper D. J. Cerebrospinal fluid pulse pressure and intracranial volume-pressure relationships. J Neurol Neurosurg Psychiatry. 1979 Aug;42(8):687–700. doi: 10.1136/jnnp.42.8.687. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Batjer H. H. Cerebral protective effects of etomidate: experimental and clinical aspects. Cerebrovasc Brain Metab Rev. 1993 Spring;5(1):17–32. [PubMed] [Google Scholar]
  6. Bedford R. F., Persing J. A., Pobereskin L., Butler A. Lidocaine or thiopental for rapid control of intracranial hypertension? Anesth Analg. 1980 Jun;59(6):435–437. [PubMed] [Google Scholar]
  7. Bell B. A., Smith M. A., Kean D. M., McGhee C. N., MacDonald H. L., Miller J. D., Barnett G. H., Tocher J. L., Douglas R. H., Best J. J. Brain water measured by magnetic resonance imaging. Correlation with direct estimation and changes after mannitol and dexamethasone. Lancet. 1987 Jan 10;1(8524):66–69. doi: 10.1016/s0140-6736(87)91908-8. [DOI] [PubMed] [Google Scholar]
  8. Bingham R. M., Procaccio F., Prior P. F., Hinds C. J. Cerebral electrical activity influences the effects of etomidate on cerebral perfusion pressure in traumatic coma. Br J Anaesth. 1985 Sep;57(9):843–848. doi: 10.1093/bja/57.9.843. [DOI] [PubMed] [Google Scholar]
  9. Braakman R., Schouten H. J., Blaauw-van Dishoeck M., Minderhoud J. M. Megadose steroids in severe head injury. Results of a prospective double-blind clinical trial. J Neurosurg. 1983 Mar;58(3):326–330. doi: 10.3171/jns.1983.58.3.0326. [DOI] [PubMed] [Google Scholar]
  10. Brown M. M., Wade J. P., Marshall J. Fundamental importance of arterial oxygen content in the regulation of cerebral blood flow in man. Brain. 1985 Mar;108(Pt 1):81–93. doi: 10.1093/brain/108.1.81. [DOI] [PubMed] [Google Scholar]
  11. Bruce D. A., Alavi A., Bilaniuk L., Dolinskas C., Obrist W., Uzzell B. Diffuse cerebral swelling following head injuries in children: the syndrome of "malignant brain edema". J Neurosurg. 1981 Feb;54(2):170–178. doi: 10.3171/jns.1981.54.2.0170. [DOI] [PubMed] [Google Scholar]
  12. Bruce D. A., Langfitt T. W., Miller J. D., Schutz H., Vapalahti M. P., Stanek A., Goldberg H. I. Regional cerebral blood flow, intracranial pressure, and brain metabolism in comatose patients. J Neurosurg. 1973 Feb;38(2):131–144. doi: 10.3171/jns.1973.38.2.0131. [DOI] [PubMed] [Google Scholar]
  13. Børgesen S. E., Gjerris F. The predictive value of conductance to outflow of CSF in normal pressure hydrocephalus. Brain. 1982 Mar;105(Pt 1):65–86. doi: 10.1093/brain/105.1.65. [DOI] [PubMed] [Google Scholar]
  14. Chan K. H., Dearden N. M., Miller J. D., Midgley S., Piper I. R. Transcranial Doppler waveform differences in hyperemic and nonhyperemic patients after severe head injury. Surg Neurol. 1992 Dec;38(6):433–436. doi: 10.1016/0090-3019(92)90111-y. [DOI] [PubMed] [Google Scholar]
  15. Chan K. H., Dearden N. M., Miller J. D. The significance of posttraumatic increase in cerebral blood flow velocity: a transcranial Doppler ultrasound study. Neurosurgery. 1992 May;30(5):697–700. [PubMed] [Google Scholar]
  16. Chan K. H., Miller J. D., Dearden N. M., Andrews P. J., Midgley S. The effect of changes in cerebral perfusion pressure upon middle cerebral artery blood flow velocity and jugular bulb venous oxygen saturation after severe brain injury. J Neurosurg. 1992 Jul;77(1):55–61. doi: 10.3171/jns.1992.77.1.0055. [DOI] [PubMed] [Google Scholar]
  17. Chan K. H., Miller J. D., Dearden N. M. Intracranial blood flow velocity after head injury: relationship to severity of injury, time, neurological status and outcome. J Neurol Neurosurg Psychiatry. 1992 Sep;55(9):787–791. doi: 10.1136/jnnp.55.9.787. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Choi D. W. Methods for antagonizing glutamate neurotoxicity. Cerebrovasc Brain Metab Rev. 1990 Summer;2(2):105–147. [PubMed] [Google Scholar]
  19. Cooper P. R., Moody S., Clark W. K., Kirkpatrick J., Maravilla K., Gould A. L., Drane W. Dexamethasone and severe head injury. A prospective double-blind study. J Neurosurg. 1979 Sep;51(3):307–316. doi: 10.3171/jns.1979.51.3.0307. [DOI] [PubMed] [Google Scholar]
  20. Czosnyka M., Batorski L., Laniewski P., Maksymowicz W., Koszewski W., Zaworski W. A computer system for the identification of the cerebrospinal compensatory model. Acta Neurochir (Wien) 1990;105(3-4):112–116. doi: 10.1007/BF01669992. [DOI] [PubMed] [Google Scholar]
  21. Czosnyka M., Harris N. G., Pickard J. D., Piechnik S. CO2 cerebrovascular reactivity as a function of perfusion pressure--a modelling study. Acta Neurochir (Wien) 1993;121(3-4):159–165. doi: 10.1007/BF01809269. [DOI] [PubMed] [Google Scholar]
  22. Czosnyka M., Pickard J., Whitehouse H., Piechnik S. The hyperaemic response to a transient reduction in cerebral perfusion pressure. A modelling study. Acta Neurochir (Wien) 1992;115(3-4):90–97. doi: 10.1007/BF01406364. [DOI] [PubMed] [Google Scholar]
  23. DeSalles A. A., Kontos H. A., Becker D. P., Yang M. S., Ward J. D., Moulton R., Gruemer H. D., Lutz H., Maset A. L., Jenkins L. Prognostic significance of ventricular CSF lactic acidosis in severe head injury. J Neurosurg. 1986 Nov;65(5):615–624. doi: 10.3171/jns.1986.65.5.0615. [DOI] [PubMed] [Google Scholar]
  24. Dearden N. M., Gibson J. S., McDowall D. G., Gibson R. M., Cameron M. M. Effect of high-dose dexamethasone on outcome from severe head injury. J Neurosurg. 1986 Jan;64(1):81–88. doi: 10.3171/jns.1986.64.1.0081. [DOI] [PubMed] [Google Scholar]
  25. Edwards A. D., Wyatt J. S., Richardson C., Potter A., Cope M., Delpy D. T., Reynolds E. O. Effects of indomethacin on cerebral haemodynamics in very preterm infants. Lancet. 1990 Jun 23;335(8704):1491–1495. doi: 10.1016/0140-6736(90)93030-s. [DOI] [PubMed] [Google Scholar]
  26. Eisenberg H. M., Frankowski R. F., Contant C. F., Marshall L. F., Walker M. D. High-dose barbiturate control of elevated intracranial pressure in patients with severe head injury. J Neurosurg. 1988 Jul;69(1):15–23. doi: 10.3171/jns.1988.69.1.0015. [DOI] [PubMed] [Google Scholar]
  27. Enevoldsen E. M., Cold G., Jensen F. T., Malmros R. Dynamic changes in regional CBF, intraventricular pressure, CSF pH and lactate levels during the acute phase of head injury. J Neurosurg. 1976 Feb;44(2):191–214. doi: 10.3171/jns.1976.44.2.0191. [DOI] [PubMed] [Google Scholar]
  28. Feldman Z., Kanter M. J., Robertson C. S., Contant C. F., Hayes C., Sheinberg M. A., Villareal C. A., Narayan R. K., Grossman R. G. Effect of head elevation on intracranial pressure, cerebral perfusion pressure, and cerebral blood flow in head-injured patients. J Neurosurg. 1992 Feb;76(2):207–211. doi: 10.3171/jns.1992.76.2.0207. [DOI] [PubMed] [Google Scholar]
  29. Fitch W., Pickard J. D., Tamura A., Graham D. I. Effects of hypotension induced with sodium nitroprusside on the cerebral circulation before, and one week after, the subarachnoid injection of blood. J Neurol Neurosurg Psychiatry. 1988 Jan;51(1):88–93. doi: 10.1136/jnnp.51.1.88. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Giannotta S. L., Weiss M. H., Apuzzo M. L., Martin E. High dose glucocorticoids in the management of severe head injury. Neurosurgery. 1984 Oct;15(4):497–501. doi: 10.1227/00006123-198410000-00004. [DOI] [PubMed] [Google Scholar]
  31. Gill R., Foster A. C., Woodruff G. N. MK-801 is neuroprotective in gerbils when administered during the post-ischaemic period. Neuroscience. 1988 Jun;25(3):847–855. doi: 10.1016/0306-4522(88)90040-1. [DOI] [PubMed] [Google Scholar]
  32. Gordon E., Rossanda M. Further studies on cerebrospinal fluid acid-base status in patients with brain lesions. Acta Anaesthesiol Scand. 1970;14(2):97–109. doi: 10.1111/j.1399-6576.1970.tb00763.x. [DOI] [PubMed] [Google Scholar]
  33. Gower D. J., Lee K. S., McWhorter J. M. Role of subtemporal decompression in severe closed head injury. Neurosurgery. 1988 Oct;23(4):417–422. doi: 10.1227/00006123-198810000-00002. [DOI] [PubMed] [Google Scholar]
  34. Harrison M. J. Influence of haematocrit in the cerebral circulation. Cerebrovasc Brain Metab Rev. 1989 Spring;1(1):55–67. [PubMed] [Google Scholar]
  35. Hasan D., Vermeulen M., Wijdicks E. F., Hijdra A., van Gijn J. Effect of fluid intake and antihypertensive treatment on cerebral ischemia after subarachnoid hemorrhage. Stroke. 1989 Nov;20(11):1511–1515. doi: 10.1161/01.str.20.11.1511. [DOI] [PubMed] [Google Scholar]
  36. Hassler W., Steinmetz H., Pirschel J. Transcranial Doppler study of intracranial circulatory arrest. J Neurosurg. 1989 Aug;71(2):195–201. doi: 10.3171/jns.1989.71.2.0195. [DOI] [PubMed] [Google Scholar]
  37. Inao S., Kuchiwaki H., Wachi A., Andoh K., Nagasaka M., Sugita K., Furuse M. Effect of mannitol on intracranial pressure-volume status and cerebral haemodynamics in brain oedema. Acta Neurochir Suppl (Wien) 1990;51:401–403. doi: 10.1007/978-3-7091-9115-6_134. [DOI] [PubMed] [Google Scholar]
  38. Inglis F., Kuroda Y., Bullock R. Glucose hypermetabolism after acute subdural hematoma is ameliorated by a competitive NMDA antagonist. J Neurotrauma. 1992 Summer;9(2):75–84. doi: 10.1089/neu.1992.9.75. [DOI] [PubMed] [Google Scholar]
  39. Izumi Y., Roussel S., Pinard E., Seylaz J. Reduction of infarct volume by magnesium after middle cerebral artery occlusion in rats. J Cereb Blood Flow Metab. 1991 Nov;11(6):1025–1030. doi: 10.1038/jcbfm.1991.170. [DOI] [PubMed] [Google Scholar]
  40. Jafar J. J., Johns L. M., Mullan S. F. The effect of mannitol on cerebral blood flow. J Neurosurg. 1986 May;64(5):754–759. doi: 10.3171/jns.1986.64.5.0754. [DOI] [PubMed] [Google Scholar]
  41. Jennett B., Teasdale G., Galbraith S., Pickard J., Grant H., Braakman R., Avezaat C., Maas A., Minderhoud J., Vecht C. J. Severe head injuries in three countries. J Neurol Neurosurg Psychiatry. 1977 Mar;40(3):291–298. doi: 10.1136/jnnp.40.3.291. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Jensen K., Ohrström J., Cold G. E., Astrup J. The effects of indomethacin on intracranial pressure, cerebral blood flow and cerebral metabolism in patients with severe head injury and intracranial hypertension. Acta Neurochir (Wien) 1991;108(3-4):116–121. doi: 10.1007/BF01418518. [DOI] [PubMed] [Google Scholar]
  43. Johnston I. H., Harper A. M. The effect of mannitol on cerebral blood flow. An experimental study. J Neurosurg. 1973 Apr;38(4):461–471. doi: 10.3171/jns.1973.38.4.0461. [DOI] [PubMed] [Google Scholar]
  44. Katzman R., Hussey F. A simple constant-infusion manometric test for measurement of CSF absorption. I. Rationale and method. Neurology. 1970 Jun;20(6):534–544. doi: 10.1212/wnl.20.6.534. [DOI] [PubMed] [Google Scholar]
  45. Kirkham F. J., Levin S. D., Padayachee T. S., Kyme M. C., Neville B. G., Gosling R. G. Transcranial pulsed Doppler ultrasound findings in brain stem death. J Neurol Neurosurg Psychiatry. 1987 Nov;50(11):1504–1513. doi: 10.1136/jnnp.50.11.1504. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. LUNDBERG N. Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Scand Suppl. 1960;36(149):1–193. [PubMed] [Google Scholar]
  47. Langfitt T. W. Increased intracranial pressure. Clin Neurosurg. 1969;16:436–471. doi: 10.1093/neurosurgery/16.cn_suppl_1.436. [DOI] [PubMed] [Google Scholar]
  48. Liang B. C., Thornton A. F., Jr, Sandler H. M., Greenberg H. S. Malignant astrocytomas: focal tumor recurrence after focal external beam radiation therapy. J Neurosurg. 1991 Oct;75(4):559–563. doi: 10.3171/jns.1991.75.4.0559. [DOI] [PubMed] [Google Scholar]
  49. Marie C., Bralet J. Blood glucose level and morphological brain damage following cerebral ischemia. Cerebrovasc Brain Metab Rev. 1991 Spring;3(1):29–38. [PubMed] [Google Scholar]
  50. Marmarou A., Maset A. L., Ward J. D., Choi S., Brooks D., Lutz H. A., Moulton R. J., Muizelaar J. P., DeSalles A., Young H. F. Contribution of CSF and vascular factors to elevation of ICP in severely head-injured patients. J Neurosurg. 1987 Jun;66(6):883–890. doi: 10.3171/jns.1987.66.6.0883. [DOI] [PubMed] [Google Scholar]
  51. Marmarou A., Shulman K., LaMorgese J. Compartmental analysis of compliance and outflow resistance of the cerebrospinal fluid system. J Neurosurg. 1975 Nov;43(5):523–534. doi: 10.3171/jns.1975.43.5.0523. [DOI] [PubMed] [Google Scholar]
  52. Meldrum B. Protection against ischaemic neuronal damage by drugs acting on excitatory neurotransmission. Cerebrovasc Brain Metab Rev. 1990 Spring;2(1):27–57. [PubMed] [Google Scholar]
  53. Mendelow A. D., Teasdale G. M., Russell T., Flood J., Patterson J., Murray G. D. Effect of mannitol on cerebral blood flow and cerebral perfusion pressure in human head injury. J Neurosurg. 1985 Jul;63(1):43–48. doi: 10.3171/jns.1985.63.1.0043. [DOI] [PubMed] [Google Scholar]
  54. Meyer F. B., Anderson R. E., Sundt T. M., Jr, Yaksh T. L. Treatment of experimental focal cerebral ischemia with mannitol. Assessment by intracellular brain pH, cortical blood flow, and electroencephalography. J Neurosurg. 1987 Jan;66(1):109–115. doi: 10.3171/jns.1987.66.1.0109. [DOI] [PubMed] [Google Scholar]
  55. Miller J. D., Butterworth J. F., Gudeman S. K., Faulkner J. E., Choi S. C., Selhorst J. B., Harbison J. W., Lutz H. A., Young H. F., Becker D. P. Further experience in the management of severe head injury. J Neurosurg. 1981 Mar;54(3):289–299. doi: 10.3171/jns.1981.54.3.0289. [DOI] [PubMed] [Google Scholar]
  56. Miller J. D., Garibi J., Pickard J. D. Induced changes of cerebrospinal fluid volume. Effects during continuous monitoring of ventricular fluid pressure. Arch Neurol. 1973 Apr;28(4):265–269. doi: 10.1001/archneur.1973.00490220073011. [DOI] [PubMed] [Google Scholar]
  57. Miller J. D., Jones P. A., Dearden N. M., Tocher J. L. Progress in the management of head injury. Br J Surg. 1992 Jan;79(1):60–64. doi: 10.1002/bjs.1800790122. [DOI] [PubMed] [Google Scholar]
  58. Miller J. D., Leech P. Effects of mannitol and steroid therapy on intracranial volume-pressure relationships in patients. J Neurosurg. 1975 Mar;42(3):274–281. doi: 10.3171/jns.1975.42.3.0274. [DOI] [PubMed] [Google Scholar]
  59. Muizelaar J. P., Lutz H. A., 3rd, Becker D. P. Effect of mannitol on ICP and CBF and correlation with pressure autoregulation in severely head-injured patients. J Neurosurg. 1984 Oct;61(4):700–706. doi: 10.3171/jns.1984.61.4.0700. [DOI] [PubMed] [Google Scholar]
  60. Muizelaar J. P., Marmarou A., Young H. F., Choi S. C., Wolf A., Schneider R. L., Kontos H. A. Improving the outcome of severe head injury with the oxygen radical scavenger polyethylene glycol-conjugated superoxide dismutase: a phase II trial. J Neurosurg. 1993 Mar;78(3):375–382. doi: 10.3171/jns.1993.78.3.0375. [DOI] [PubMed] [Google Scholar]
  61. Muizelaar J. P., Wei E. P., Kontos H. A., Becker D. P. Mannitol causes compensatory cerebral vasoconstriction and vasodilation in response to blood viscosity changes. J Neurosurg. 1983 Nov;59(5):822–828. doi: 10.3171/jns.1983.59.5.0822. [DOI] [PubMed] [Google Scholar]
  62. Muizelaar J. P., van der Poel H. G., Li Z. C., Kontos H. A., Levasseur J. E. Pial arteriolar vessel diameter and CO2 reactivity during prolonged hyperventilation in the rabbit. J Neurosurg. 1988 Dec;69(6):923–927. doi: 10.3171/jns.1988.69.6.0923. [DOI] [PubMed] [Google Scholar]
  63. Murphy P. G., Myers D. S., Davies M. J., Webster N. R., Jones J. G. The antioxidant potential of propofol (2,6-diisopropylphenol). Br J Anaesth. 1992 Jun;68(6):613–618. doi: 10.1093/bja/68.6.613. [DOI] [PubMed] [Google Scholar]
  64. Nelson R. J., Czosnyka M., Pickard J. D., Maksymowicz W., Perry S., Martin J. L., Lovick A. H. Experimental aspects of cerebrospinal hemodynamics: the relationship between blood flow velocity waveform and cerebral autoregulation. Neurosurgery. 1992 Oct;31(4):705–710. doi: 10.1227/00006123-199210000-00013. [DOI] [PubMed] [Google Scholar]
  65. Nelson R. J., Roberts J., Rubin C., Walker V., Ackery D. M., Pickard J. D. Association of hypovolemia after subarachnoid hemorrhage with computed tomographic scan evidence of raised intracranial pressure. Neurosurgery. 1991 Aug;29(2):178–182. doi: 10.1097/00006123-199108000-00002. [DOI] [PubMed] [Google Scholar]
  66. Newell D. W., Aaslid R., Stooss R., Reulen H. J. The relationship of blood flow velocity fluctuations to intracranial pressure B waves. J Neurosurg. 1992 Mar;76(3):415–421. doi: 10.3171/jns.1992.76.3.0415. [DOI] [PubMed] [Google Scholar]
  67. Nordström C. H., Messeter K., Sundbärg G., Schalén W., Werner M., Ryding E. Cerebral blood flow, vasoreactivity, and oxygen consumption during barbiturate therapy in severe traumatic brain lesions. J Neurosurg. 1988 Mar;68(3):424–431. doi: 10.3171/jns.1988.68.3.0424. [DOI] [PubMed] [Google Scholar]
  68. Obrist W. D., Langfitt T. W., Jaggi J. L., Cruz J., Gennarelli T. A. Cerebral blood flow and metabolism in comatose patients with acute head injury. Relationship to intracranial hypertension. J Neurosurg. 1984 Aug;61(2):241–253. doi: 10.3171/jns.1984.61.2.0241. [DOI] [PubMed] [Google Scholar]
  69. Pappius H. M., Dayes L. A. Hypertonic urea. Its effect on the distribution of water and electrolytes in normal and edematous brain tissues. Arch Neurol. 1965 Oct;13(4):395–402. doi: 10.1001/archneur.1965.00470040061010. [DOI] [PubMed] [Google Scholar]
  70. Park C. K., Nehls D. G., Graham D. I., Teasdale G. M., McCulloch J. The glutamate antagonist MK-801 reduces focal ischemic brain damage in the rat. Ann Neurol. 1988 Oct;24(4):543–551. doi: 10.1002/ana.410240411. [DOI] [PubMed] [Google Scholar]
  71. Pickard J. D., Bailey S., Sanderson H., Rees M., Garfield J. S. Steps towards cost-benefit analysis of regional neurosurgical care. BMJ. 1990 Sep 29;301(6753):629–635. doi: 10.1136/bmj.301.6753.629. [DOI] [PMC free article] [PubMed] [Google Scholar]
  72. Pickard J. D., Mackenzie E. T. Inhibition of prostaglandin synthesis and the response of baboon cerebral circulation to carbon dioxide. Nat New Biol. 1973 Oct 10;245(145):187–188. doi: 10.1038/newbio245187a0. [DOI] [PubMed] [Google Scholar]
  73. REED D. J., WOODBURY D. M. Effect of hypertonic urea on cerebrospinal fluid pressure and brain volume. J Physiol. 1962 Nov;164:252–264. doi: 10.1113/jphysiol.1962.sp007018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  74. Ravussin P., Abou-Madi M., Archer D., Chiolero R., Freeman J., Trop D., De Tribolet N. Changes in CSF pressure after mannitol in patients with and without elevated CSF pressure. J Neurosurg. 1988 Dec;69(6):869–876. doi: 10.3171/jns.1988.69.6.0869. [DOI] [PubMed] [Google Scholar]
  75. Reid A., Marchbanks R. J., Bateman D. E., Martin A. M., Brightwell A. P., Pickard J. D. Mean intracranial pressure monitoring by a non-invasive audiological technique: a pilot study. J Neurol Neurosurg Psychiatry. 1989 May;52(5):610–612. doi: 10.1136/jnnp.52.5.610. [DOI] [PMC free article] [PubMed] [Google Scholar]
  76. Roberts P. A., Pollay M., Engles C., Pendleton B., Reynolds E., Stevens F. A. Effect on intracranial pressure of furosemide combined with varying doses and administration rates of mannitol. J Neurosurg. 1987 Mar;66(3):440–446. doi: 10.3171/jns.1987.66.3.0440. [DOI] [PubMed] [Google Scholar]
  77. Robertson C. S., Narayan R. K., Gokaslan Z. L., Pahwa R., Grossman R. G., Caram P., Jr, Allen E. Cerebral arteriovenous oxygen difference as an estimate of cerebral blood flow in comatose patients. J Neurosurg. 1989 Feb;70(2):222–230. doi: 10.3171/jns.1989.70.2.0222. [DOI] [PubMed] [Google Scholar]
  78. Ropper A. H., O'Rourke D., Kennedy S. K. Head position, intracranial pressure, and compliance. Neurology. 1982 Nov;32(11):1288–1291. doi: 10.1212/wnl.32.11.1288. [DOI] [PubMed] [Google Scholar]
  79. Rosner M. J., Becker D. P. Origin and evolution of plateau waves. Experimental observations and a theoretical model. J Neurosurg. 1984 Feb;60(2):312–324. doi: 10.3171/jns.1984.60.2.0312. [DOI] [PubMed] [Google Scholar]
  80. Rosner M. J., Coley I. B. Cerebral perfusion pressure, intracranial pressure, and head elevation. J Neurosurg. 1986 Nov;65(5):636–641. doi: 10.3171/jns.1986.65.5.0636. [DOI] [PubMed] [Google Scholar]
  81. Saul T. G., Ducker T. B. Effect of intracranial pressure monitoring and aggressive treatment on mortality in severe head injury. J Neurosurg. 1982 Apr;56(4):498–503. doi: 10.3171/jns.1982.56.4.0498. [DOI] [PubMed] [Google Scholar]
  82. Saul T. G., Ducker T. B., Salcman M., Carro E. Steroids in severe head injury: A prospective randomized clinical trial. J Neurosurg. 1981 May;54(5):596–600. doi: 10.3171/jns.1981.54.5.0596. [DOI] [PubMed] [Google Scholar]
  83. Schalén W., Messeter K., Nordström C. H. Cerebral vasoreactivity and the prediction of outcome in severe traumatic brain lesions. Acta Anaesthesiol Scand. 1991 Feb;35(2):113–122. doi: 10.1111/j.1399-6576.1991.tb03258.x. [DOI] [PubMed] [Google Scholar]
  84. Schwartz M. L., Tator C. H., Rowed D. W., Reid S. R., Meguro K., Andrews D. F. The University of Toronto head injury treatment study: a prospective, randomized comparison of pentobarbital and mannitol. Can J Neurol Sci. 1984 Nov;11(4):434–440. doi: 10.1017/s0317167100045960. [DOI] [PubMed] [Google Scholar]
  85. Shimoda M., Oda S., Tsugane R., Sato O. Intracranial complications of hypervolemic therapy in patients with a delayed ischemic deficit attributed to vasospasm. J Neurosurg. 1993 Mar;78(3):423–429. doi: 10.3171/jns.1993.78.3.0423. [DOI] [PubMed] [Google Scholar]
  86. Smith H. P., Kelly D. L., Jr, McWhorter J. M., Armstrong D., Johnson R., Transou C., Howard G. Comparison of mannitol regimens in patients with severe head injury undergoing intracranial monitoring. J Neurosurg. 1986 Dec;65(6):820–824. doi: 10.3171/jns.1986.65.6.0820. [DOI] [PubMed] [Google Scholar]
  87. Sullivan L. P., Stears J. C., Ringel S. P. Resolution of syringomyelia and Chiari I malformation by ventriculoatrial shunting in a patient with pseudotumor cerebri and a lumboperitoneal shunt. Neurosurgery. 1988 Apr;22(4):744–747. doi: 10.1227/00006123-198804000-00022. [DOI] [PubMed] [Google Scholar]
  88. Symon L., Dorsch N. W., Stephens R. J. Pressure waves in so-called low-pressure hydrocephalus. Lancet. 1972 Dec 16;2(7790):1291–1292. doi: 10.1016/s0140-6736(72)92658-x. [DOI] [PubMed] [Google Scholar]
  89. Ward J. D., Becker D. P., Miller J. D., Choi S. C., Marmarou A., Wood C., Newlon P. G., Keenan R. Failure of prophylactic barbiturate coma in the treatment of severe head injury. J Neurosurg. 1985 Mar;62(3):383–388. doi: 10.3171/jns.1985.62.3.0383. [DOI] [PubMed] [Google Scholar]
  90. Welch K. The intracranial pressure in infants. J Neurosurg. 1980 May;52(5):693–699. doi: 10.3171/jns.1980.52.5.0693. [DOI] [PubMed] [Google Scholar]
  91. Welsh F. A., Sims R. E., Harris V. A. Mild hypothermia prevents ischemic injury in gerbil hippocampus. J Cereb Blood Flow Metab. 1990 Jul;10(4):557–563. doi: 10.1038/jcbfm.1990.98. [DOI] [PubMed] [Google Scholar]
  92. Wolf A. L., Levi L., Marmarou A., Ward J. D., Muizelaar P. J., Choi S., Young H., Rigamonti D., Robinson W. L. Effect of THAM upon outcome in severe head injury: a randomized prospective clinical trial. J Neurosurg. 1993 Jan;78(1):54–59. doi: 10.3171/jns.1993.78.1.0054. [DOI] [PubMed] [Google Scholar]
  93. Wyatt J. S., Cope M., Delpy D. T., Wray S., Reynolds E. O. Quantification of cerebral oxygenation and haemodynamics in sick newborn infants by near infrared spectrophotometry. Lancet. 1986 Nov 8;2(8515):1063–1066. doi: 10.1016/s0140-6736(86)90467-8. [DOI] [PubMed] [Google Scholar]

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