ICP: tumor: corrected mechanism

Clinical - Neurologic

The process by which intracranial tumors produce cerebral compression was initially described over one hundred years ago. (Source 1)

In the normal adult, intracranial contents (i.e. cellular mass, blood, and CSF) have a combined volume of 1200-1500 cm^3. (Source 2). The presence of a tumor (or other mass lesion, e.g. hematoma) increases intracranial volume. When the cranium is closed, an increase in intracranial volume would necessarily result in an increase in intracranial pressure (ICP) due to the rigid enclosure of the skull. This change in pressure given a change in volume is commonly referred to as elastance (the inverse of compliance).

Neurologic injury triggers a complex host of processes that result in cerebral cytotoxic and vasogenic edema, which worsens ICP by further increasing intravascular volume (Ref. 1, 2). This vicious cycle leads to worsening clinical symptoms: drowsiness and headache progressing to hypertension and bradycardia, followed ultimately by loss of consciousness, fixed and dilated pupils, hypotension, and death (Source 3).

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2008

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