Epidural monitoring of the intracranial pressure in severe head injury characterized by non-localizing motor response.
Recent studies on prognostic variables and the intensive care of head injuries enabled us to select 64 patients and administer a standard treatment protocol to prevent secondary brain injury. All the patients were in coma with a flexor motor pattern as the best response between 6 and 24 hours after the accident and/or decompressive surgery. Continuous epidural intracranial pressure (ICP) monitoring was used in all patients to control the effect of positioning, analgetics, hyperventilation and osmotherapy. None of the patients with a normal initial ICP (15 mm Hg or less) developed an ICP increase leading to brain tamponade. A subsequent further rise to 40 mm Hg signified a very high risk of progression towards brain tamponade. The majority of the patients (71%) with a maximum ICP increase of less than 40 mm Hg had an acceptable recovery. After 6-12 months, the outcome in this series of patients was 48% with a good/moderate recovery, 14% with severe deficits and 38% dead/vegetative.
D001924:Brain Concussion / Q000175:diagnosis; D001926:Brain Death; D001929:Brain Edema / Q000175:diagnosis; D001930:Brain Injuries / Q000175:diagnosis* / Q000628:therapy; D003128:Coma / Q000175:diagnosis; D003131:Combined Modality Therapy; D004824:Epidural Space; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis; D007427:Intracranial Pressure; D009119:Muscle Contraction; D009460:Neurologic Examination / Q000379:methods; D011379:Prognosis; D014057:Tomography, X-Ray Computed