Document Detail

Monitoring intracranial pressure in patients with malignant middle cerebral artery infarction: is it useful?
MedLine Citation:
PMID:  19663552     Owner:  NLM     Status:  MEDLINE    
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.
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    
Department of Neurosurgery, Vall d'Hebron University Hospital, Institut Recerca Vall d'Hebron, Autonomous University of Barcelona, 08035 Barcelona, Spain.
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MeSH Terms
Anisocoria / diagnosis,  radiography,  therapy
Brain / pathology
Cohort Studies
Decompressive Craniectomy
Hypothermia, Induced
Infarction, Middle Cerebral Artery / diagnosis*,  radiography,  therapy
Intracranial Pressure*
Middle Aged
Monitoring, Physiologic
Prospective Studies
Pupil Disorders / diagnosis,  radiography,  therapy
Tomography, X-Ray Computed

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