Head and Spinal Cord Injury: Diagnosis and Management

In modern neurotraumatology, intracranial pressure (ICP) management is a central tenet. The incidence of raised ICP or intracranial hypertension (ICHTN) is very high in modern neurotrauma units. In patients with demonstrable mass lesions, up to 63% may have ICHTN. By contrast, up to 13% of patients with a normal initial computed tomogram of head (CT Head) may have ICHTN. Elevated ICP, in turn, is an independent predictor of worse outcomes in patients with severe traumatic brain injury (TBI). Increased ICP is also directly related to increased mortality in such patients. In patients with sustained ICHTN, control of ICP within thresholds leads to improved outcomes. In addition, inability to control ICP is a predictor of poor outcomes. Since the 1970s, significant reductions in morbidity and mortality have been achieved in patients with severe TBI with intensive management protocols. ICP control is an integral part of management protocols.