TREATMENT OF INTRACRANIAL HYPERTENSION FR OM SEVERE HEAD-INJURY

More than 50% of severely head-injured patients develop increased intr acranial pressure, risking exacerbating ischaemic insults to the alrea dy injured brain. In approximatly 10% of these cases, intracranial pre ssure may become unresponsive to medical or surgical treatment, with a resulting mortality of over 90%, The main emphasis should be on full intensive care, based on the prophylaxis of the devastating effects of secondary insults to the injured brain. Specific treatment should be directed towards controlling intracranial pressure and maintaining a c erebral perfusion pressure over 70 mmHg, while avoiding, where feasibl e, treatment modalities at risk of exacerbating cerebral ischaemia. Re cently, an algorithm for treating intracranial hypertension under thre e different therapeutic situations has been suggested, based on the su ccessive application of effective agents with increasing associated ri sks, Therapeutic modalities of this protocol are discussed.