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Lundberg ICP Waves — FRCA Final MCQ

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HardNeuroanaesthesiaLundberg ICP WavesFRCA Final

A 55-year-old man on the ICU has an ICP bolt in situ. The ICP trace shows repeated plateau waves (Lundberg A waves) lasting 5-20 minutes with ICP rising to 50-80 mmHg. What do Lundberg A waves indicate?

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Correct answer: A — Severely impaired intracranial compliance with imminent risk of herniation

Lundberg A waves (plateau waves) are pathological ICP elevations to 50-100 mmHg lasting 5-20 minutes. They indicate severely reduced intracranial compliance and failing cerebral autoregulation. They are a pre-herniation sign and require urgent intervention (osmotic therapy, CSF drainage, surgical decompression). Lundberg B waves (1-2/min, amplitude 20-50 mmHg) indicate moderately reduced compliance. Lundberg C waves (4-8/min, amplitude <20 mmHg) are normal physiological variations.

Reference: Brain Trauma Foundation – 2016 – TBI guidelines; NACCS – 2023 – Neuroanaesthesia guidelines