Introduction:Measuring intracranial pressure (ICP) and treating intracranial hypertension after severe traumatic brain injury (TBI) are mainstays of care and preventing even brief episodes could be beneficial. It has been suggested that cerebral edema/swelling increase within the first 3d after injury, implying that intracranial hypertension should be anticipated within this time period. However, the time course of intracranial hypertension has been the subject of limited evaluation. Using a system of continuous collection of vital signs (including ICP), we sought to define the onset of intracranial hypertension after severe TBI in children. Methods: Children after severe TBI (GCS ≤ 8) were studied, with ICP collected every minute for up to 7d after admission. All children were treated with guidelines-based protocolized neurocritical care. The time to the first intracranial hypertension event (ICP >20 mm Hg for >5 min) was determined and the time from arrival to ICP monitor placement along with the number of intracranial hypertension episodes were calculated. Data are presented as mean ± SEM, unless otherwise indicated. Results: Data from 22 children were available with a total of 2964 h of monitoring (mean age = 8.1 ± 1.2 y; median GCS = 7; 59% male; 53% favorable outcome; 18% mortality). ICP monitor placement occurred at 5.0 ± 0.5 h from ER presentation. The mean time to intracranial hypertension was 26.6 ± 5.7 h, with only 2 children experiencing the first episode at >72h. The mean number of discrete intracranial hypertension events was 9.5 ± 1.7, the duration of these events varied greatly. In subset analysis, children with abusive head trauma (n=5) did not exhibit differences in intracranial hypertension timing vs. children with accidental injuries. Conclusions: Our data support the hypothesis that most children suffer the first intracranial hypertension event within the first 48h, but early intracranial hypertension (within 24 h) was frequently observed. Analysis of a larger cohort of children could provide additional insight into the onset of intracranial hypertension based on mechanisms of injury or other factors and aid in defining an optimal approach to prevent rather than respond to these secondary insults. Support: T32HD40686 Introduction: Statin use following aneurysmal subarachnoid hemorrhage (aSAH) remains controversial. The benefit of acute statin treatment in patients previously treated with statins is unknown. We tested the hypothesis that preadmission statin use would improve functional outcomes and delayed cerebral ischemic events among patients acutely treated with pravastatin. Methods: We prospectively identified patients with aSAH treated with pravastatin according to our hospital protocol. Functional outcomes were assessed using the modified Ranking scale (mRS) at 14 days, 28 days and 3 months. Delayed cerebral ischemia was assessed using clinical evaluation and cerebral angiography. Results: Patients on statins prior to admission were more likely to have a history of diabetes, hypertensio...
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