ICP waveform

Q: In intracranial pressure (ICP) waveform, P2 represents intracranial compliance?

A) True

B) False

Answer: A

ICP monitoring waveform has a flow of 3 upstrokes in one wave.

P1 = (percussion wave) represents arterial pulsation

P2 = (Tidal wave) represents intracranial compliance

P3 = (Dicrotic wave) represents aortic valve closure

In normal ICP waveform, P1 should have the highest upstroke, P2 in between, and P3 should show the lowest upstroke (A in the figure below).

If P2 is higher than P1 - it indicates intracranial hypertension (B in the figure below).

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References:

1. Czosnyka M, Pickard JD. Monitoring and interpretation of intracranial pressure. J Neurol Neurosurg Psychiatry. 2004 Jun;75(6):813-21. doi: 10.1136/jnnp.2003.033126. PMID: 15145991; PMCID: PMC1739058.

2. Kirkness CJ, Mitchell PH, Burr RL, March KS, Newell DW. Intracranial pressure waveform analysis: clinical and research implications. J Neurosci Nurs. 2000 Oct;32(5):271-7. doi: 10.1097/01376517-200010000-00007. PMID: 11089200.