Advertisement

Intracranial Hypertension After Spontaneous Intracerebral Hemorrhage: A Systematic Review and Meta-analysis of Prevalence and Mortality Rate

  • Daniel Agustín GodoyEmail author
  • Rafael A. Núñez-Patiño
  • Andres Zorrilla-Vaca
  • Wendy C. Ziai
  • J. Claude HemphillIII
Review Article
  • 250 Downloads

Abstract

The objective of this study was to determine the prevalence of intracranial hypertension (IHT) and the associated mortality rate in patients who suffered from primary intracerebral hemorrhage (ICH). A secondary objective was to assess predisposing factors to IHT development. We conducted a systematic literature search of major electronic databases (MEDLINE, EMBASE, and Cochrane Library), for studies that assessed intracranial pressure (ICP) monitoring in patients with acute ICH. Study level and outcome measures were extracted. The meta-analysis was performed using a random-effects model. A total of six studies comprising 381 patients were pooled to estimate the overall prevalence of any episode of IHT (ICP > 20 mmHg) after ICH. The pooled prevalence rate for any episode of IHT after ICH was 67% (95% CI 51–84%). Four studies comprising 239 patients were pooled in order to estimate the overall mortality rate associated with IHT. Pooled mortality rate was 50% (95% CI 24–76%). For both outcomes, heterogeneity was statistically significant, and risk of bias was nonsignificant. Reported variables correlated significantly with increased ICP were lower Glasgow Coma Scale score at admission, midline shift, hemorrhage volume, and hydrocephalus. The prevalence and mortality rates associated with IHT after ICH are high and may be underestimated. Predicting factors for the development of IHT reflect the magnitude of the primary injury. However, the results of present meta-analysis should be interpreted with caution due to methodological limitations such as selection bias of patients who had ICP monitoring, and lack of standardized IHT definition.

Keywords

Intracerebral hemorrhage Intracranial hypertension Intracranial pressure Meta-analysis Prevalence Mortality 

Abbreviations

ICH

Intracerebral hemorrhage

ICP

Intracranial pressure

GOS

Glasgow Outcome Scale

IHT

Intracranial hypertension

EVD

External ventricular drain

IVH

Intraventricular hemorrhage

CSF

Cerebrospinal fluid

Notes

Author Contribution

DAG: design of the study, definition of intellectual content, literature search, data acquisition, data analysis, manuscript editing and manuscript preparation. RAN: design of the study, definition of intellectual content, literature search, data acquisition, data analysis, statistical analyses, manuscript editing and manuscript preparation. AZ: design of the study, data analysis, statistical analyses and manuscript editing. WCZ, JCH: definition of intellectual content, data acquisition, data analysis and manuscript editing.

Source of support

None.

Compliance with ethical standards

Conflict of interest

Daniel A. Godoy, Rafael A. Núñez-Patiño, Andres Zorrilla-Vaca and J. Claude Hemphill declares that they have no conflict of interest and Dr. Ziai reports personal fees from Headsense, Inc., outside the submitted work.

References

  1. 1.
    Hemphill JC 3rd, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, Fung GL, Goldstein JN, Macdonald RL, Mitchell PH, Scott PA, Selim MH, Woo D. American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke. 2015;46:2032–60.CrossRefGoogle Scholar
  2. 2.
    de Oliveira Manoel AL, Goffi A, Zampieri FG, Turkel-Parrella D, Duggal A, Marotta TR, Macdonald RL, Abrahamson S. The critical care management of spontaneous intracranial hemorrhage: a contemporary review. Crit Care. 2016;20:272.  https://doi.org/10.1186/s13054-016-1432-0.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Thabet AM, Kottapally M, Hemphill JC 3rd. Management of intracerebral hemorrhage. Handb Clin Neurol. 2017;140:177–94.CrossRefGoogle Scholar
  4. 4.
    Rincon F, Mayer SA. Novel therapies for intracerebral hemorrhage. Curr Opin Crit Care. 2004;10:94–100.CrossRefGoogle Scholar
  5. 5.
    Godoy DA, Piñero GR, Koller P, Masotti L, Di Napoli M. Steps to consider in the approach and management of critically ill patient with spontaneous intracerebral hemorrhage. World J Crit Care Med. 2015;4(3):213–29.CrossRefGoogle Scholar
  6. 6.
    Keep RF, Hua Y, Xi G. Intracerebral haemorrhage: mechanisms of injury and therapeutic targets. Lancet Neurol. 2012;11:720–31.CrossRefGoogle Scholar
  7. 7.
    Becker KJ, Baxter AB, Cohen WA, Bybee HM, Tirschwell DL, Newell DW, Winn HR, Longstreth WT Jr. Withdrawal of support in intracerebral hemorrhage may lead to self-fulfilling prophecies. Neurology. 2001;56:766–72.CrossRefGoogle Scholar
  8. 8.
    Hemphill JC 3rd, Newman J, Zhao S, Johnston SC. Hospital usage of early do-not-resuscitate orders and outcome after intracerebral hemorrhage. Stroke. 2004;35:1130–4.CrossRefGoogle Scholar
  9. 9.
    Zahuranec DB, Morgenstern LB, Sánchez BN, Resnicow K, White DB, Hemphill JC III. Do-not-resuscitate orders and predictive models after intracerebral hemorrhage. Neurology. 2010;75(7):626–33.CrossRefGoogle Scholar
  10. 10.
    Zahuranec DB, Brown DL, Lisabeth LD, Gonzales NR, Longwell PJ, Smith MA, Garcia NM, Morgenstern LB. Early care limitations independently predict mortality after intracerebral hemorrhage. Neurology. 2007;68(20):1651–7.CrossRefGoogle Scholar
  11. 11.
    Zurasky JA, Aiyagari V, Zazulia AR, Shackelford A, Diringer MN. Early mortality following spontaneous intracerebral hemorrhage. Neurology. 2005;64(4):725–7.CrossRefGoogle Scholar
  12. 12.
    Naidech AM, Bernstein RA, Bassin SL, Garg RK, Liebling S, Bendok BR, Batjer HH, Bleck TP. How patients die after intracerebral hemorrhage. Neurocrit Care. 2009;11(1):45–9.CrossRefGoogle Scholar
  13. 13.
    Zheng H, Chen C, Zhang J, Hu Z. Mechanism and therapy of brain edema after intracerebral hemorrhage. Cerebrovasc Dis. 2016;42:155–69.CrossRefGoogle Scholar
  14. 14.
    Godoy DA, Videtta W, Di Napoli M. Practical approach to posttraumatic intracranial hypertension according to pathophysiologic reasoning. Neurol Clin. 2017;35(4):613–40.CrossRefGoogle Scholar
  15. 15.
    Steiner T, Al-Shahi Salman R, Beer R, Christensen H, Cordonnier C, Csiba L, Forsting M, Harnof S, Klijn CJ, Krieger D, Mendelow AD, Molina C, Montaner J, Overgaard K, Petersson J, Roine RO, Schmutzhard E, Schwerdtfeger K, Stapf C, Tatlisumak T, Thomas BM, Toni D, Unterberg A, Wagner M. European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage. Int J Stroke. 2014;9:840–55.CrossRefGoogle Scholar
  16. 16.
    Bero L, Rennie D. The cochrane collaboration. Preparing, maintaining, and disseminating systematic reviews of the effects of health care. JAMA. 1995;274:1935–8.CrossRefGoogle Scholar
  17. 17.
    Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097.CrossRefGoogle Scholar
  18. 18.
    Wells G, Shea B, O’Connell B et al. The Newcastle–Ottawa scale (NOS) for assessing the quality of non-randomised studies in meta-analyses. Ottawa: University of Ottawa; 2009.Google Scholar
  19. 19.
    DerSimonian R, Kacker R. Random-effects model for meta-analysis of clinical trials: an update. Contemp Clin Trials. 2007;28:105–14.CrossRefGoogle Scholar
  20. 20.
    Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.CrossRefGoogle Scholar
  21. 21.
    Hara M, Kadowaki C, Shiogai T, Takeuchi K. Correlation between intracranial pressure (ICP) and changes in CT images of cerebral hemorrhage. Neurol Res. 1998;20:225–30.CrossRefGoogle Scholar
  22. 22.
    Kamel H, Hemphill J. Characteristics and sequelae of intracranial hypertension after intracerebral hemorrhage. Neurocrit Care. 2012;17:172–6.CrossRefGoogle Scholar
  23. 23.
    Ziai W, Melnychuk E, Thompson C, Awad I, Lane K, Hanley D. Occurrence and impact of intracranial pressure elevation during treatment of severe intraventricular hemorrhage. Crit Care Med. 2012;40:1601–8.CrossRefGoogle Scholar
  24. 24.
    Sykora M, Steinmacher S, Steiner T, Poli S, Diedler J. Association of intracranial pressure with outcome in comatose patients with intracerebral hemorrhage. J Neurol Sci. 2014;342:141–5.CrossRefGoogle Scholar
  25. 25.
    Diedler J, Santos E, Poli S, Sykora M. Optimal cerebral perfusion pressure in patients with intracerebral hemorrhage: an observational case series. Crit Care. 2014;18:R51.CrossRefGoogle Scholar
  26. 26.
    Su W, Gao C, Wang P, Huang J, Qian Y, Guo L, Zhang J, Jiang R. Correlation of circulating T lymphocytes and intracranial hypertension in intracerebral hemorrhage. World Neurosurg. 2017;107:389–95.CrossRefGoogle Scholar
  27. 27.
    Janny P, Colnet G, Georget AM, Chazal J. Intracranial pressure with intracerebral hemorrhages. Surg Neurol. 1978;10:371–5.PubMedGoogle Scholar
  28. 28.
    Hamani C, Zanetti MV, Campos Gomez Pinto F, Ferreira Andrade A, Ciquini O Jr, Marino R Jr. Intraventricular pressure monitoring in patients with thalamic and ganglionic hemorrhages. Arq Neuropsiquiatr. 2003;61(2-B):376–80.CrossRefGoogle Scholar
  29. 29.
    Ropper A, King R. Intracranial pressure monitoring in comatose patients with cerebral hemorrhage. Arch Neurol. 1984;41:725–8.CrossRefGoogle Scholar
  30. 30.
    Fernandes HM, Siddique S, Banister K, Chambers I, Wooldridge T, Gregson B, Mendelow AD. Continuous monitoring of ICP and CPP following ICH and its relationship to clinical, radiological and surgical parameters. Acta Neurochir Suppl. 2000;76:463–6.PubMedGoogle Scholar
  31. 31.
    Papo I, Janny P, Caruselli G, Colnet G, Luongo A. Intracranial pressure time course in primary intracerebral hemorrhage. Neurosurgery. 1979;4:504–11.CrossRefGoogle Scholar
  32. 32.
    Janny P, Papo I, Chazal J, Colnet G, Barreto LC. Intracranial hypertension and prognosis of spontaneous intracerebral haematomas. A correlative study of 60 patients. Acta Neurochir (Wien). 1982;61:181–6.CrossRefGoogle Scholar
  33. 33.
    Duff TA, Ayeni S, Levin AB, Javid M. Nonsurgical management of spontaneous intracerebral hematoma. Neurosurgery. 1981;9:387–93.CrossRefGoogle Scholar
  34. 34.
    Tewari MK, Tripathi M, Sharma RR, Mishra GP, Lad SD. Surgical management of moderate sized spontaneous cerebellar hematomas: role of intracranial pressure monitoring. Turk Neurosurg. 2015;25:712–20.PubMedGoogle Scholar
  35. 35.
    Zeng J, Zheng P, Tong W, Fang W. Decreased risk of secondary brain herniation with intracranial pressure monitoring in patients with haemorrhagic stroke. BMC Anesthesiol. 2014;14:19.CrossRefGoogle Scholar
  36. 36.
    Tian Y, Wang Z, Jia Y, Li S, Wang B, Wang S, Sun L, Zhang J, Chen J, Jiang R. Intracranial pressure variability predicts short-term outcome after intracerebral hemorrhage: a retrospective study. J Neurol Sci. 2013;330:38–44.CrossRefGoogle Scholar
  37. 37.
    Ko SB, Choi HA, Parikh G, Helbok R, Schmidt JM, Lee K, Badjatia N, Claassen J, Connolly ES, Mayer SA. Multimodality monitoring for cerebral perfusion pressure optimization in comatose patients with intracerebral hemorrhage. Stroke. 2011;42:3087–92.CrossRefGoogle Scholar
  38. 38.
    Berlin T, Murray-Krezan C, Yonas H. Comparison of parenchymal and ventricular intracranial pressure readings utilizing a novel multi-parameter intracranial access system. SpringerPlus. 2015;4:10.CrossRefGoogle Scholar
  39. 39.
    Godoy D, Videtta W, Di Napoli M. Practical approach to posttraumatic intracranial hypertension according to pathophysiologic reasoning. Neurol Clin. 2017;35:613–40.CrossRefGoogle Scholar
  40. 40.
    Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W, et al. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med. 2012;367:2471–81.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2018

Authors and Affiliations

  • Daniel Agustín Godoy
    • 1
    Email author
  • Rafael A. Núñez-Patiño
    • 2
  • Andres Zorrilla-Vaca
    • 3
    • 4
  • Wendy C. Ziai
    • 3
    • 5
  • J. Claude HemphillIII
    • 6
  1. 1.Neurointensive Care Unit, Sanatorio Pasteur, Intensive Care UnitHospital San Juan BautistaCatamarcaArgentina
  2. 2.Faculty of Health Sciences, School of MedicinePontificia Universidad JaverianaCaliColombia
  3. 3.Department of Anesthesiology and Critical Care MedicineThe Johns Hopkins HospitalBaltimoreUSA
  4. 4.Faculty of Health, Universidad del ValleHospital Universitario del ValleCaliColombia
  5. 5.Division of Neurosciences Critical Care, Departments of Neurology, Anesthesiology and Critical Care MedicineThe Johns Hopkins University School of MedicineBaltimoreUSA
  6. 6.Kenneth Rainin Endowed Chair in Neurocritical Care, Professor of Neurology and Neurological SurgeryUniversity of CaliforniaSan FranciscoUSA

Personalised recommendations