Increased Intracranial Pressure and Pulmonary Edema

CARD1OVASCULAR response to raised intracranial pressure was first noted in the nineteenth century. 1~ Cushing gave meaning to this response when he demonstrated that the diastolic blood pressure always rose to a level slightly greater than that of the intracranial pressure5 This pressor response thus serves to maintain the circulation within the cranial cavity. Several groups of investigators have further characterized aspects of the hemodynamic response to increases in intracranial pressure; 2-4'(;'7'1j'I ~'16''-'~' however, none has studied the cardiovascular response that occurs with graded elevations in intracranial pressure. We have recently encountered 11 patients with pulmonary edema associated with increased intracranial pressure in the absence of concomitant cardiovascular or pulmonary disease. ~ These patients were all young, ranging in age from 12 to 44 years. Our laboratory experience has indicated that pulmonary edema can be elicited in about 20% of normal dogs and monkeys by the sustained elevation of intracranial pressure." The present experiments were performed to delineate both the systemic and pulmonary hemodynamic responses of higher primates to graded increases in intracranial pressure and thereby to understand both the Cushing reflex and the finding of pulmonary edema.

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