Pract Neurol 14:152-158 doi:10.1136/practneurol-2014-000811
  • Review

Management of raised intracranial pressure and hyperosmolar therapy

  1. Allan H Ropper
  1. Correspondence to Dr Allan H Ropper, Department of Neurology, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA


The management of raised intracranial pressure is undergoing rapid change. The choice of medical treatments to reduce intracranial pressure varies between institutions and regions of the world. The mainstay of therapy, however, continues to be the infusion of a hyperosmolar solution to achieve an osmotic gradient to force the exit of water from the brain. This review introduces the basic concepts of raised intracranial pressure, summarises several recent studies that have challenged dogma in the field, and provides practical advice on hyperosmolar treatment, based on personal experience and a critical reading of the literature.

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