2024 AANS Neurosurgical Topics for APPs - On-Demand-Emergent and Non-Emergent Management of Elevated Intracranial Pressure- Richard Schmidt

Emergent and Non-Emergent Management of Elevated Intracranial Pressure- Richard Schmidt

Video Transcription

Video Summary

Dr. Schmidt, a clinical assistant professor at Thomas Jefferson University, presented a lecture on managing elevated intracranial pressure (ICP), emphasizing the importance of distinguishing between emergent and non-emergent cases. He highlighted the Monroe-Kelly Doctrine, outlining the fixed volume composition of brain parenchyma, cerebrospinal fluid (CSF), and blood in the intracranial space, and the compensatory shifts that occur with volumetric changes. Dr. Schmidt explained that increased ICP affects cerebral perfusion pressure, a critical factor in brain tissue viability. Normal physiological ICP is less than 15 mmHg, with pathological elevation considered above 20 mmHg.<br /><br />Management strategies differ based on whether ICP elevation is acute or chronic. For acute cases, initial interventions include basic resuscitation and sometimes surgical decompression. Chronic elevation cases, such as with pseudotumor cerebri or hydrocephalus, are often managed medically or surgically through CSF diversion or stenting. He discussed various ICP monitoring methods, the significance of targeted therapies like mannitol, hypertonic saline, and the use of EVDs.<br /><br />Finally, Dr. Schmidt responded to questions about long-term ICP monitoring post-craniectomy, EVD management, and considerations for complications like blockages or infections. The session aimed to enhance understanding and improve treatment outcomes for patients with altered ICP.

Keywords

elevated intracranial pressure

Monroe-Kelly Doctrine

cerebral perfusion pressure

acute ICP management

chronic ICP management

CSF diversion

ICP monitoring

mannitol therapy

EVD complications