Characteristics and Sequelae of Intracranial Hypertension After Intracerebral Hemorrhage
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ORIGINAL ARTICLE
Characteristics and Sequelae of Intracranial Hypertension After Intracerebral Hemorrhage Hooman Kamel • J. Claude Hemphill III
Published online: 26 July 2012 Ó Springer Science+Business Media, LLC 2012
Abstract Introduction The characteristics and sequelae of intracranial hypertension after ICH are unclear. Methods In a cohort of patients with spontaneous ICH, we obtained ICP values from nursing documentation of hourly vital signs and reviewed charts to rule out spurious ICP recordings. We used multiple logistic regression to explore factors associated with intracranial hypertension, and ordinal logistic regression controlling for the ICH score to examine the relationship between intracranial hypertension and the mRS score at 12 months. Results Among 243 patients, 57 (24 %) underwent ICP monitoring, of whom 40 (70 %; 95 % CI 57–82 %) had an episode of ICP > 20 mmHg. Intracranial hypertension was less likely in older patients (OR per decade 0.6, 95 % CI 0.3–0.9) and after infratentorial hemorrhage (OR 0.1, 95 % CI 0–0.7). Intracranial hypertension was not independently associated with mRS scores (OR 0.8, 95 % CI 0.3–2.3); this remained true for a threshold of >25 mmHg (OR 0.5, 95 % CI 0.2–1.5), number of elevations (OR 0.98 per elevation, 95 % CI 0.96–1.00), or area under the curve (OR 1.00 per mmHg 9 h, 95 % CI 0.99–1.01). Among patients with intracranial hypertension, seven (18 %) were functionally independent (mRS 0–2) at 12 months. Our results were not significantly changed after excluding patients with early DNR orders. H. Kamel (&) Department of Neurology and Neuroscience, Weill Cornell Medical College, 525 East 68th St, F610, New York, NY 10065, USA e-mail: [email protected] J. C. Hemphill III Department of Neurology, University of California, San Francisco, USA
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Conclusion Intracranial hypertension is common after ICH, especially in younger patients with supratentorial hemorrhage. Given active treatment of elevated ICP, intracranial hypertension does not appear associated with long-term outcomes, suggesting that ICP elevations should not necessarily be taken to signify a poor prognosis. Keywords Intracerebral hemorrhage Intracranial pressure Intracranial hypertension
Introduction Intracerebral hemorrhage (ICH) affects over 100,000 Americans per year, of whom 50 % die and another 30 % remain disabled [1]. Despite this significant burden, it remains a disease without specific proven therapies [2]. Therefore, its management is often guided by physiologic considerations, one of which is the management of intracranial pressure (ICP). However, there remains a paucity of published data on the incidence, predictors, and impact on outcome of elevated ICP after ICH. Thus, ICP management recommendations in current ICH guidelines [2] follow closely those from traumatic brain injury (TBI) [3]. ICP monitors are sometimes placed in patients with severe ICH because it may be clinically and radiographically difficult to determine whether local mass effect has resulted in global intracranial
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