Monroe-Kellie doctrine

The skull is a rigid container of constant volume. The Monro-Kelly doctrine states that any increase in the volume of one of its contents must be compensated for by a reduction in volume of another if a rise in intracranial pressure (ICP) is to be avoided. 

Cerebral edema occurs in response to a wide variety of insults, including ischemia, hypoxia, infection, and noninfectious inflammation. Shifts in brain water, which is the basis of the cellular swelling, are due to osmotic forces, and result in increases in intra- and extracellular spaces. A reasonable amount of tissue swelling can be tolerated in most parts of the body, however, the restrictions imposed by the rigid tentorium and bony skull cause life-threatening herniation with relatively small increases in the brain compartments. Two early anatomists, Monroe (1733-1817) and Kellie (1758-1829), recognized that increased intracranial pressure due to swelling in the cerebrospinal fluid (CSF), blood, or brain tissue compartments could increase intracranial pressure the concept of limited expansion capacity of the intracranial contents is called the Monroe-Kellie doctrine. 

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