Imperial College London
Portrait Picture

Professor Mark Wilson

Faculty of Medicine, Department of Surgery & Cancer

Professor of Practice
 
 
 
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Contact

 

+44 (0)20 7594 1532m.wilson

 
 
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Location

 

Cambridge WingSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Wilson:2016:10.1177/0271678X16648711,
author = {Wilson, MH},
doi = {10.1177/0271678X16648711},
journal = {Journal of Cerebral Blood Flow & Metabolism},
pages = {1338--1350},
title = {Monro-Kellie 2.0: The dynamic vascular and venous pathophysiological components of intracranial pressure},
url = {http://dx.doi.org/10.1177/0271678X16648711},
volume = {36},
year = {2016}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - For 200 years, the ‘closed box’ analogy of intracranial pressure (ICP) has underpinned neurosurgery and neuro-critical care. Cushing conceptualised the Monro-Kellie doctrine stating that a change in blood, brain or CSF volume resulted in reciprocal changes in one or both of the other two. When not possible, attempts to increase a volume further increase ICP. On this doctrine’s “truth or relative untruth” depends many of the critical procedures in the surgery of the central nervous system. However, each volume component may not deserve the equal weighting this static concept implies. The slow production of CSF (0.35 ml/min) is dwarfed by the dynamic blood in and outflow (∼700 ml/min). Neuro-critical care practice focusing on arterial and ICP regulation has been questioned. Failure of venous efferent flow to precisely match arterial afferent flow will yield immediate and dramatic changes in intracranial blood volume and pressure. Interpreting ICP without interrogating its core drivers may be misleading. Multiple clinical conditions and the cerebral effects of altitude and microgravity relate to imbalances in this dynamic rather than ICP per se. This article reviews the Monro-Kellie doctrine, categorises venous outflow limitation conditions, relates physiological mechanisms to clinical conditions and suggests specific management options.
AU  - Wilson,MH
DO  - 10.1177/0271678X16648711
EP  - 1350
PY  - 2016///
SN  - 0271-678X
SP  - 1338
TI  - Monro-Kellie 2.0: The dynamic vascular and venous pathophysiological components of intracranial pressure
T2  - Journal of Cerebral Blood Flow & Metabolism
UR  - http://dx.doi.org/10.1177/0271678X16648711
UR  - http://hdl.handle.net/10044/1/33056
VL  - 36
ER  -
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