4.3 Article

Frequency of Sustained Intracranial Pressure Elevation during Treatment of Severe Intraventricular Hemorrhage

Journal

CEREBROVASCULAR DISEASES
Volume 27, Issue 4, Pages 403-410

Publisher

KARGER
DOI: 10.1159/000209241

Keywords

Intracerebral hemorrhage; Thrombolysis; Intracranial pressure; Stroke; Hydrocephalus

Funding

  1. Eleanor Naylor Dana Fellowship
  2. American Academy of Neurology
  3. NIH/NINDS [1RO1 NS 24282-08]
  4. Food and Drug Administration Orphan Products Development Agency [FD-R-001693-01-1]
  5. France Merrick Foundation
  6. FOOD AND DRUG ADMINISTRATION [R01FD001693] Funding Source: NIH RePORTER
  7. NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE [R01NS024282] Funding Source: NIH RePORTER

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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 8 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. Copyright (C) 2009 S. Karger AG, Basel

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