ArticleScientific reports2020
An update to the Monro-Kellie doctrine to reflect tissue compliance after severe ischemic and hemorrhagic stroke.
Article in Scientific reports, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers.
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Who cites it
23 citing papers in PubMed, 35 citations in OpenAlex.
- Improving physiological monitoring and reporting standards in preclinical stroke research.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2026Review
- Automated Diffusion-Weighted MRI Analysis for Exploratory Risk Stratification of Malignant Cerebral Edema After Acute Ischemic Stroke.Diagnostics (Basel, Switzerland) · 2026Article
- CT Quantification of Intraventricular Hemorrhage Volume in Poor-Grade Aneurysmal Subarachnoid Hemorrhage: Impact on Mortality and Long-Term Disability.Neurocritical care · 2026Article
- Incidence and characterization of spontaneous pituitary neuroendocrine tumors in aged spontaneously hypertensive rats.Scientific reports · 2025Article
- Evaluating the Monro-Kellie Doctrine: Contralateral Hemisphere Shrinkage in Intracerebral Hemorrhage Patients.Translational stroke research · 2025Article
- Brain fluid physiology in ischaemic stroke; more than just oedema.Fluids and barriers of the CNS · 2025Review
- Noninvasive Method Using Mechanical Extensometer for the Estimation of Intracranial Compliance by Repeated Measures Agreement Analysis.Neurocritical care · 2025Article
- The Role of ICP Monitoring in Minimally Invasive Surgery for the Management of Intracerebral Hemorrhage.Translational stroke research · 2025Review
- No Benefit of 3% Hypertonic Saline Following Experimental Intracerebral Hemorrhage.Neurotoxicity research · 2024Article
- Review of the Brain's Behaviour after Injury and Disease for Its Application in an Agent-Based Model (ABM).Biomimetics (Basel, Switzerland) · 2024Review
- Hemorrhage Volume Drives Early Brain Injury and Outcome in Poor-Grade Aneurysmal SAH.AJNR. American journal of neuroradiology · 2024Article
- Tissue Compliance and Intracranial Pressure Responses to Large Intracerebral Hemorrhage in Young and Aged Spontaneously Hypertensive Rats.Hypertension (Dallas, Tex. : 1979) · 2024Article
- Article
- Intracranial Pressure Dysfunction Following Severe Intracerebral Hemorrhage in Middle-Aged Rats.Translational stroke research · 2023Article
- Intracranial pressure for clinicians: it is not just a number.Journal of anesthesia, analgesia and critical care · 2023Review
- The Monro-Kellie Doctrine: A Review and Call for Revision.AJNR. American journal of neuroradiology · 2023Review
- Relationship between edema and intracranial pressure following intracerebral hemorrhage in rat.Frontiers in stroke · 2023Review
- Early, Intense Rehabilitation Fails to Improve Outcome After Intra-Striatal Hemorrhage in Rats.Neurorehabilitation and neural repair · 2022Article
- Editorial: Cerebrospinal fluid dynamics and intracranial pressure elevation-Novel insights on molecular and physiological mechanisms, and implications for neurological disease.Frontiers in molecular neuroscience · 2022Article
- Molecular, Pathological, Clinical, and Therapeutic Aspects of Perihematomal Edema in Different Stages of Intracerebral Hemorrhage.Oxidative medicine and cellular longevity · 2022Review
Corrections and comments
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Authors and funding
8 authors at 3 institutions in 1 country.
Funding
Abstract
High intracranial pressure (ICP) can impede cerebral blood flow resulting in secondary injury or death following severe stroke. Compensatory mechanisms include reduced cerebral blood and cerebrospinal fluid volumes, but these often fail to prevent raised ICP. Serendipitous observations in intracerebral hemorrhage (ICH) suggest that neurons far removed from a hematoma may shrink as an ICP compliance mechanism. Here, we sought to critically test this observation. We tracked the timing of distal tissue shrinkage (e.g. CA1) after collagenase-induced striatal ICH in rat; cell volume and density alterations (42% volume reduction, 34% density increase; p < 0.0001) were highest day one post-stroke, and rebounded over a week across brain regions. Similar effects were seen in the filament model of middle cerebral artery occlusion (22% volume reduction, 22% density increase; p ≤ 0.007), but not with the Vannucci-Rice model of hypoxic-ischemic encephalopathy (2.5% volume increase, 14% density increase; p ≥ 0.05). Concerningly, this 'tissue compliance' appears to cause sub-lethal damage, as revealed by electron microscopy after ICH. Our data challenge the long-held assumption that 'healthy' brain tissue outside the injured area maintains its volume. Given the magnitude of these effects, we posit that 'tissue compliance' is an important mechanism invoked after severe strokes.
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Registered trials
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