Characteristics and Sequelae of Intracranial Hypertension After Intracerebral Hemorrhage
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- Kamel, H. & Hemphill, J.C. Neurocrit Care (2012) 17: 172. doi:10.1007/s12028-012-9744-7
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The characteristics and sequelae of intracranial hypertension after ICH are unclear.
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.
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.
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.