Intracranial Pressure and how it can cause a Catastrophic Brain Injury

Intracranial pressure (ICP) is best defined as the pressure that is exerted on the brain by an outside force. When what might be called the “ICP system” is properly working, ICP consists of and is created by a normal amount and distribution of cerebrospinal fluid (CSF) and blood in and around the brain.

However, physical and neurological problems can arise when the “ICP system” malfunctions and ICP becomes excessive, generally defined as pressure more than 20mm Hg^[1]. Under normal conditions, a steady volume of cerebrospinal fluid, blood and brain tissue are held inside of the solid skull. When normal levels exist, a predictable, steady ICP is placed on the brain. But a rise in the volume of CSF (from hydrocephalus) or blood (from brain bleeding), or both, can increase ICP. This is because the hard skull has a fixed capacity, is unable to expand and therefore, pressure within it builds. A “pressure cooker” may be an apt analogy. Left undiagnosed and untreated at the acute level, an abnormally high ICP can result in a catastrophic brain injury.

Some potential causes of increased ICP include:

• Traumatic brain injury (TBI): In a TBI, a sudden event that results in a direct strike on the head may result in brain damage. Alternatively, the resulting jar back and forth jar, such as in an auto collision may damage the brain. The initial injury can cause brain tissue to swell. In addition, broken pieces of bone can rupture blood vessels in any part of the head. The body’s response to the injury may also increase swelling and therefore, ICP.
• Ischemic strokes: Ischemic stroke is the most common type of stroke and is caused by a blood clot or blockage in or near the brain. The brain is unable to receive the blood — and oxygen — it needs to function. As a result, brain cells start to die.
• Brain hemorrhages and strokes: A hemorrhagic stroke is among the most common types of stroke, and results from blood leaking from a blood vessel. As blood leaks and the body responds, pressure builds inside the brain.
• Infections: Some infections may cause or contribute to ICP, including meningitis and encephalitis.
• Tumors: Brain tumors can cause swelling in several ways, including pressing against other parts of the brain and blocking the flow of CSF, resulting increased ICP.

Abnormal intracranial pressure is known by other terms, by other names, including cerebral edema, brain edema and elevated intracranial pressure.

Abnormal ICP can be focal or diffuse, meaning that it can occur in a localized area (focal) or throughout the brain (diffuse). Whatever the type, it can be catastrophic because abnormally high ICP can prevent blood from flowing to the brain, depriving it of the oxygen it needs to function. Swelling can also block other fluids from leaving the brain, making the swelling even worse. Damage or death of brain cells may result.

The determination of the type and location(s) of the ICP is indicative of many things. These include the long-range outlook for the individual, the functional effects of the traumatic brain injury on him or her, acute rehabilitation, the development of a customized Client Goal Plan, neurorehabilitative and other clinically relevant post-acute services that will be needed to advance the client in his or her activities of daily living (ADLs) and further toward independence.

The professionals at NeuLife, including its team of neurologists, RNs and therapists are expert in the provision of innovative, clinically relevant services, including the development of a Client Goal Plan, and delivery of neurobehavioral and neurorehabilitative services. NeuLife’s goal is to provide post-acute rehabilitation to its clients to achieve the best possible outcome for those who have even the most difficult and challenging diagnoses.

NeuLife’s philosophy is that healing, wellness and personal fulfillment are best accomplished in a positive and uplifting therapeutic environment where caring staff encourage, assist and support each client so he or she may achieve specific goals. NeuLife believes personal fulfillment is equally as important as goals to increase function and independence. NeuLife seeks to achieve, for all of its clients, maximized, sustained outcomes that exceed the expectations of all persons served.

NeuLife, in Mount Dora, Florida, is a fully accessible residential post-acute program providing specialized rehabilitation to individuals diagnosed with traumatic brain injury (TBI), spinal cord injury (SCI), traumatic amputations and other catastrophic injuries.

2725 Robie Avenue

Mount Dora, Florida 32757