Koljusiseses

Koljusiseses is an Estonian term describing anything related to the intracranial space, i.e., the structures and processes located inside the skull. This includes brain tissue, cerebrospinal fluid (CSF), and intracranial blood. The skull forms a fixed, rigid container, so the volume inside remains relatively constant.

An important principle in koljusiseses is the Monro-Kellie doctrine, which states that the sum of the volumes of brain tissue, CSF, and blood within the skull is constant. If one component increases, another must decrease to maintain stable pressure. When this balance is disrupted, intracranial pressure (ICP) rises, risking brain tissue compression and reduced blood flow.

Intracranial pressure is normally about 7–15 mmHg in adults. Sustained elevation can cause symptoms such as headache, nausea, vomiting, and altered consciousness, and, in severe cases, brain herniation. Papilledema may develop with longer-term raised ICP, and a Cushing reflex can occur in critical situations, marked by high blood pressure and slowed heart rate.

Monitoring and imaging are used to assess koljusiseses. Invasive ICP monitoring, via an external ventricular drain or intraparenchymal sensor, provides continuous data. Initial imaging typically involves a CT scan; MRI offers more detail for certain conditions.

Common causes of raised koljusiseses include traumatic brain injury, intracerebral or subarachnoid hemorrhage, large strokes, brain tumors, hydrocephalus, and cerebral edema. Management aims to protect brain tissue and maintain adequate cerebral perfusion, employing measures such as airway support, head elevation, osmotic therapy, cautious BP management, and, when needed, surgical decompression or CSF drainage.