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The relationship between intracranial pressure, disturbances of brain function and prognosis

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Summary

Long term measurements of the ventricular CSF pressure were made in 236 patients, before and after brain operations or trauma. Neither a definite rise in daily average pressure, nor the daily maximum values proved of any value in determining the prognosis when considered on their own. However, an analysis of the V F P over the course of several days, in relation to the simultaneous disturbances of neurological function, and particularly level of consciousness and brain metabolism (as shown by the CSF lactate levels), gives a much clearer indication as regards the prognosis. Thus, no patient survived when, after the fourth post-operative/post-traumatic day, there still persisted an average daily rise of V F P over 20 mm Hg which was associated with coma and a CSF lactate level of over 2.0 mmol/l.

Zusammenfassung

Es wurden kontinuierliche Langzeitmessungen des Ventrikelliquordruckes bei 236 Patienten vor und nach Hirnoperationen bzw. nach Hirntraumen vorgenommen. Weder eine deutliche Erhöhung des Ventrikelliquordruckes im Tagesdurchschnitt noch der Tages-Maximalwerte ergaben, für sich allein genommen, eine ganz enge Beziehung zur Prognose. Aber eine Analyse des Ventrikelliquordruckes im mehrtägigen Verlauf in Verbindung mit gleichzeitigen Störungen der neurologischen Funktionen, besonders des Bewußtseins, und des Hirnmetabolismus in Form des Liquor-Laktatspiegels, geben deutliche prognostische Hinweise. So überlebte kein Patient, bei welchem nach dem 4. postoperativen bzw. posttraumatischen Tag noch eine tagesdurchschnittliche Erhöhung des Ventrikelliquordruckes über 20 mm Hg mit Coma und einem Liquor-Laktatgehalt über 2,0 mmol/l verbunden blieb.

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Authors and Affiliations

  1. Neurochirurgische Universitätsklinik, Köln, Germany

    K. E. Richard & R. A. Frowein

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  1. K. E. Richard
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  2. R. A. Frowein
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Additional information

Dedicated to Professor Dr. Dr. h. c. W. Tönnis on his 80th birthday.

This paper was supported in part by the Grant of the Deutsche Forschungsgemeinschaft, 53 Bonn — Bad Godesberg.

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Richard, K.E., Frowein, R.A. The relationship between intracranial pressure, disturbances of brain function and prognosis. Neurosurg. Rev. 1, 25–36 (1978). https://doi.org/10.1007/BF01647458

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