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. Author manuscript; available in PMC: 2010 Feb 25.
Published in final edited form as: Ped Health. 2009;3(6):533–541. doi: 10.2217/phe.09.54

Figure 1. The Munro–Kellie Doctrine explains the relationship between intracranial volumes and intracranial pressure in physiological and pathophysiological conditions.

Figure 1

The volume of the intracranial vault (the area represented by the rectangle) is generally fixed in adults and most children. The contents of the intracranial vault in the normal condition include the brain, arterial blood, venous blood and CSF, and are maintained at a relatively low ICP (Panel 1; normal). After an injury, swelling/edema/pathological tissue can increase within the brain (Panel 2; compensated). Compensatory mechanisms, including increased CSF absorption, extrusion of CSF into the spinal canal and extrusion of venous blood into the thorax, initially limit any changes in ICP. When these compensatory changes are exhausted (Panel 3; uncompensated), any further increases in intracranial volumes are associated with concomitant increases in ICP that eventually can compromise arterial blood flow, ultimately leading to cerebral herniation. CSF: Cerebrospinal fluid; ICP: Intracranial pressure.