Frequency of sustained intracranial pressure elevation during treatment of severe intraventricular hemorrhage.
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 +/- 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.
Ziai
Wendy C
WC
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. weziai@jhmi.edu
Torbey
Michel T
MT
Naff
Neal J
NJ
Williams
Michael A
MA
Bullock
Ross
R
Marmarou
Anthony
A
Tuhrim
Stanley
S
Schmutzhard
Eric
E
Pfausler
Bettina
B
Hanley
Daniel F
DF
D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000188:drug therapy*; D004311:Double-Blind Method; D004322:Drainage / Q000295:instrumentation / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006849:Hydrocephalus / Q000628:therapy; D007276:Injections, Intraventricular; D019586:Intracranial Hypertension / Q000453:epidemiology* / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator