It has been a matter of general knowledge for many years that the most important finding in acute traumatic injury to the brain is increased intracranial pressure. This is caused by three factors: swelling of the brain due to hemorrhage, congestion and edema; increase in the amount of cerebrospinal fluid in the ventricles and cisterns; and increase in blood pressure. In a general way, the reaction of these three factors on one another may be explained as follows: The brain, encased and protected within a rigid bone box and covered by a thick, practically nondistensible dura mater, has little excess space to accommodate the hemorrhage, congestion and edema that accompany injury. As the cortex becomes swollen, it presses tightly against the dura and cranium and restricts the outflow of cerebrospinal fluid and blood through the cranial sinuses. This backpressure on the cerebrospinal fluid, whose production is increased by the active
JACKSON H. EFFECT OF HYPERTONIC DEXTROSE SOLUTIONS ON INTRACRANIAL PRESSURE: IN ACUTE CRANIAL INJURIES. JAMA. 1933;100(10):731–733. doi:10.1001/jama.1933.02740100025010
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