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


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.


Intracerebral hemorrhage Intracranial hypertension Intracranial pressure Meta-analysis Prevalence Mortality 



Intracerebral hemorrhage


Intracranial pressure


Glasgow Outcome Scale


Intracranial hypertension


External ventricular drain


Intraventricular hemorrhage


Cerebrospinal fluid


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


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.


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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

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