The prognostic reliability of intracranial pressure monitoring and MRI data in severe traumatic brain injury.
The predictive quality of intracranial pressure (ICP) monitoring has for many years been a matter of debate. We correlate ICP data comparing MRI data with the outcome after severe traumatic brain injury to evaluate their prognostic potency.



This study compares the results of ICP monitoring, MRI, coma duration and outcome according to Glasgow Outcome Scale obtained in 32 patients having suffered severe TBI. Level of significance was set to p≤0.05 in statistical tests.



The MRI results were closely correlated with coma duration and Glasgow Outcome Scale, but the ICP measurements were not. With the exception of severe, bipontine lesions, there is no other region of the brain in which increased evidence of traumatogenic lesions emerges as the intracranial pressure rises. Just bipontine lesions that proof to be infaust correlate with elevated ICP values.



ICP monitoring does not allow individual prognostic conclusions to be made. Implantation of an intracranial pressure sensor alone for making a prognostic estimate is not advisable. The use of intracranial pressure measurements in the retrospective appraisal of disease progress is highly problematic. However, MRI diagnostic in patients with severe TBI improves prognostic potency of clinical parameters.
Klinik für Neurochirurgie, Klinikum Landshut, Robert-Koch-Strasse 1, 84034 Landshut, Germany. Electronic address: dieter.woischneck@klinikum-landshut.de.
Dieter
D
Woischneck
Klinik für Neurochirurgie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany. Electronic address: Thomas.Kapapa@uniklinik-ulm.de.
Thomas
T
Kapapa
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000503:physiopathology*; D002648:Child; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D007427:Intracranial Pressure / Q000502:physiology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D055815:Young Adult
Intensive care; Midbrain; Outcome; Pons; Prognosis