About Brain Injury: Intracranial Pressure

"Does the brain always swell? How do you know if the brain is swelling? Doesn't the CT scan show swelling? Is it possible that Jamey's brain did not swell because of the use of the drug manitol (protocol treatment in all ICU's)? Is the chemical released if there is no swelling? If Jamey didn't need a shunt, can we assume there was no swelling?"

[Stewart:]

"Here are my amateur observations."

"Pretty much all tissues in the body swell when traumatized. They also require more oxygen to heal. There are some special things about the brain:

1) It rests inside a bone case, so when it swells, it experiences more trauma;

2) The more damage the brain receives, the more oxygen it needs and the more it swells. "

The more damage the brain receives, the more it swells. This is caused by leakage from blood vessels. When the brain swells, because it is housed inside the skull, it has no room to expand. This leads to a rise in pressure within the brain. This rise in pressure rapidly equals the arterial pressure thereby affecting the blood flow to the brain.

This diffuse pressure which decreases blood flow affects the ability of the cells within the brain to metabolize properly; the cells are unable to eliminate toxins which then accumulate.

[Stewart:]

"This phenomenon leads to a spiral effect which is what kills brain injured people who don't get prompt attention. One of the big breakthroughs that lead to the survival rate we have now for brain injury today was learning to break this cycle."

We are still very much in the stage of learning to break this cycle. The most significant factor has been the use of monitoring devices to inform treatments to prevent further damage.

"After each of my wife's head injuries (1980 and 1991), most of what the neurosurgeons had to say was about maintaining oxygen levels and controlling swelling in Karen's brain during the acute stage of her recovery. It always bothered me because as important as it is, it sounds pretty trivial; keeping someone suffused with oxygen should hardly require a surgeon." ~ Stewart C. O'Dell

The brain requires both oxygen and glucose.

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In response to the trauma, changes occur in the brain which require monitoring to prevent further damage. The brain's size frequently increases after a severe head injury. This is called brain swelling and occurs when there is an increase in the amount of blood to the brain.

Later in the illness water may collect in the brain which is called Brain Edema. Both Brain swelling and Brain Edema result in excessive pressure in the brain called Intracranial Pressure (ICP).

Around-the-clock monitoring during this time is essential in order that Intracranial Pressure can be immediately treated. Treatment of brain swelling can be difficult.

Very strong medications are administered. Medications which help to draw fluid back out of the brain and into blood vessels may be useful. Some medications help by decreasing the metabolic requirements of the brain. Other medications increase blood flow into the brain which can help diminish the spiral effect caused by brain swelling.

In some cases, removal of small amounts of fluids or from the brain or surgery may be beneficial. And in some cases, removal of damaged tissue may prevent further damage.

 

Understanding Coma Rancho Los Amigos Scale/ The Levels of Coma Objectives of Neurosurgery A Guide to Brain Anatomy A Glossary of Terms

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