Monday, July 30, 2012

Characteristics and Sequelae of Intracranial Hypertension After Intracerebral Hemorrhage

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 × 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.
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.

  • Content Type Journal Article
  • Category Original Article
  • Pages 1-5
  • DOI 10.1007/s12028-012-9744-7
  • Authors
    • Hooman Kamel, Department of Neurology and Neuroscience, Weill Cornell Medical College, 525 East 68th St, F610, New York, NY 10065, USA
    • J. Claude Hemphill III, Department of Neurology, University of California, San Francisco, USA





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