Document Detail

Frequency of sustained intracranial pressure elevation during treatment of severe intraventricular hemorrhage.
MedLine Citation:
PMID:  19295201     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Elevated intracranial pressure (ICP) is an important marker of neurological deterioration. The occurrence and significance of elevated ICP and low cerebral perfusion pressure (CPP) in aggressively treated spontaneous intraventricular hemorrhage (IVH) are not defined.
METHODS: We performed a secondary longitudinal exploratory data analysis of a randomized multicenter trial of urokinase (UK) versus placebo (Pcb) as a treatment for IVH. Eleven IVH patients who required an external ventricular drain (EVD) were randomized to receive either intraventricular UK or Pcb every 12 h until clinical response permitted EVD removal. ICP and CPP were recorded every 4 or 6 h, as well as before and 1 h after EVD closure for administration of study agent. ICP, CPP and the proportion of ICP readings above 20, 30, 40 and 50 mm Hg were analyzed.
RESULTS: Six UK and 5 Pcb patients aged 39-74 years (mean +/- standard deviation; 53 +/- 11 years) were enrolled. Initial ICP ranged from 0 to 38 mm Hg (10.9 +/- 11.0), initial CPP from 65 to 133 mm Hg (100.5 +/- 17.7). We recorded 472 ICP readings over the entire monitoring period. Of these 65 (14%) were >20 mm Hg, 23 (5%) >30 mm Hg, 9 (2%) >40 mm Hg and 3 (<1%) >50 mm Hg. Only 2 of 141 intraventricular injections of study agent with EVD closure were not tolerated and required reopening of the EVD.
CONCLUSIONS: In the intensive care unit, initial ICP measured with an EVD was uncommonly elevated (1/11 patients) in this group of severe IVH patients despite acute obstructive hydrocephalus. Frequent monitoring reveals ICP elevation >20 mm Hg in 14% of observations during use of EVD. ICP elevation, though it can occur, is not routinely associated with EVD closure for thrombolytic treatment with UK.
Wendy C Ziai; Michel T Torbey; Neal J Naff; Michael A Williams; Ross Bullock; Anthony Marmarou; Stanley Tuhrim; Eric Schmutzhard; Bettina Pfausler; Daniel F Hanley
Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.     Date:  2009-03-18
Journal Detail:
Title:  Cerebrovascular diseases (Basel, Switzerland)     Volume:  27     ISSN:  1421-9786     ISO Abbreviation:  Cerebrovasc. Dis.     Publication Date:  2009  
Date Detail:
Created Date:  2009-04-02     Completed Date:  2009-07-09     Revised Date:  2013-06-02    
Medline Journal Info:
Nlm Unique ID:  9100851     Medline TA:  Cerebrovasc Dis     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  403-10     Citation Subset:  IM    
Copyright Information:
Copyright 2009 S. Karger AG, Basel.
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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MeSH Terms
Cerebral Hemorrhage / drug therapy*
Double-Blind Method
Drainage / instrumentation,  methods
Fibrinolytic Agents / administration & dosage,  adverse effects,  therapeutic use*
Hydrocephalus / therapy
Injections, Intraventricular
Intracranial Hypertension / epidemiology*,  therapy
Longitudinal Studies
Middle Aged
Monitoring, Physiologic
Risk Factors
Thrombolytic Therapy / methods*
Time Factors
Urokinase-Type Plasminogen Activator / administration & dosage,  adverse effects,  therapeutic use*
Grant Support
1R01 NS 24282-08/NS/NINDS NIH HHS; FD-R-001693-01-1/FD/FDA HHS
Reg. No./Substance:
0/Fibrinolytic Agents; EC Plasminogen Activator
Comment In:
Cerebrovasc Dis. 2009;27(4):411-2   [PMID:  19295202 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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