| Monitoring intracranial pressure in patients with malignant middle cerebral artery infarction: is it useful? | |
| | |
MedLine Citation:
|
PMID: 19663552 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECT: Intracranial pressure (ICP) monitoring is increasingly used in the treatment of patients with malignant middle cerebral artery (MCA) infarction. However, neurological deterioration may exist independent from intracranial hypertension. This study aimed to present the findings of continuous ICP monitoring in a cohort of patients with malignant MCA infarction and to correlate these findings with clinical and radiological features. METHODS: The authors studied a prospective cohort of 25 patients with malignant MCA infarction consecutively admitted to the neurotrauma intensive care unit of the Vall d'Hebron University Hospital between March 2002 and September 2006. The patients were treated using a combined protocol of initial moderate hypothermia and hemicraniectomy. The latter was performed when patients showed a midline shift (MLS) > or = 5 mm or ICP > 20 mm Hg. Six patients had an MLS > or = 5 mm on the first CT scan and underwent surgery without prior ICP monitoring. This study focuses on the subgroup of 19 patients who underwent intraparenchymatous ICP monitoring before surgery. RESULTS: Intracranial pressure readings were evaluated and correlated with pupillary abnormalities, MLS, and ischemic tissue volume. In 12 of the 19 patients, ICP values were always < or = 20 mm Hg, despite a mean (+/- SD) MLS of 6.7 +/- 2 mm and a mean ischemic tissue volume of 241.3 +/- 83 cm(3). In 2 patients with anisocoria, ICP values were also normal. CONCLUSIONS: In patients with a malignant MCA infarction, pupillary abnormalities and severe brainstem compression may be present despite normal ICP values. Therefore, continuous ICP monitoring cannot substitute for close clinical and radiological follow-up in the management of these patients. |
| | |
Authors:
|
Maria Antonia Poca; Bessy Benejam; Juan Sahuquillo; Marilyn Riveiro; Laura Frascheri; Maria Angels Merino; Pilar Delgado; Jose Alvarez-Sabin |
Publication Detail:
|
Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
|
Title: Journal of neurosurgery Volume: 112 ISSN: 1933-0693 ISO Abbreviation: J. Neurosurg. Publication Date: 2010 Mar |
Date Detail:
|
Created Date: 2010-03-02 Completed Date: 2010-04-08 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 0253357 Medline TA: J Neurosurg Country: United States |
Other Details:
|
Languages: eng Pagination: 648-57 Citation Subset: AIM; IM |
Affiliation:
|
Department of Neurosurgery, Vall d'Hebron University Hospital, Institut Recerca Vall d'Hebron, Autonomous University of Barcelona, 08035 Barcelona, Spain. pocama@neurotrauma.net |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Aged Anisocoria / diagnosis, radiography, therapy Brain / pathology Cohort Studies Decompressive Craniectomy Female Humans Hypothermia, Induced Infarction, Middle Cerebral Artery / diagnosis*, radiography, therapy Intracranial Pressure* Male Middle Aged Monitoring, Physiologic Prospective Studies Pupil Disorders / diagnosis, radiography, therapy Tomography, X-Ray Computed |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Management of direct carotid-cavernous sinus fistulas with the use of ethylene-vinyl alcohol (Onyx) ...
Next Document: Three-dimensional volume-rendering technique in the angiographic follow-up of intracranial aneurysms...