Elevated intracranial pressure (ICP) is a common clinical condition in critically ill patients with neurological injuries such as traumatic brain injury, intracerebral hemorrhage, and acute ischemic stroke. Elevated ICP is often caused by cerebral edema, a swelling of the brain that is largely dependent on primary pathology and intracellular changes. The Monro-Kellie doctrine states that the sum of volumes of cerebrospinal fluid, brain, and blood is constant and that an increase in any of the intracranial compartments should be balanced by a decrease in the other components. As the skull is an inflexible, enclosed space, inability to achieve pressure-volume equilibrium results in intracranial hypertension and ischemia. The normal adult ICP ranges from 5 to 15 mm Hg, and an ICP greater than 20 mm Hg indicates intracranial hypertension requiring treatment. Elevated ICP is associated with worse clinical outcomes; therefore, appropriate treatment should be initiated immediately.

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