Hemispheric strokes: clinical or surgical management? Intracranial pressure monitoring of a case and review of the literature

Abstract

SUMMARY -The authors report a case of a right hemispheric ischemic infarction on a 77-year-old patient that was monitored with an extradural intracranial pressure monitor (Ladd device).We show the huge intracranial hypertension that the brain was submitted despite of the medical treatment. The treatment of hemispheric strokes can be very challenging. The usual antiedema drugs very often prove to be of no help against the mass effect and the high intracranial pressure that some patients present. More recently reports on the literature are showing good results following a decompressive surgery on such ischemic infarcts.KEY WORDS: intracranial pressure, monitoring, hemispheric stroke, hemicraniectomy Acidentes cerebrovasculares hemisféricos: conduta clínica ou cirúrgica? Monitorização da pressão intracraniana em um caso e revisão da literatura RESUMO -Os autores apresentam um caso clínico de infarto hemisférico em paciente de 77 anos, no qual a pressão intracraniana foi monitorizada. Apesar do tratamento clínico realizado, a pressão intracraniana se manteve PALAVRAS-CHAVE: monitorização da pressão intracraniana, acidente cerebrovascular hemisférico, hemicraniectomia.The application and importance of intracranial pressure (ICP) monitoring are already well established on post-traumatic intracranial injuries and spontaneous hypertensive hemorrhages 119 . The literature shows the aid of this method concerning therapeutic decisions, approaches and on relationship with the patient's outcome 13 . On the other hand, only a few reports were done, analysing the ICP monitoring in ischemic events 23 , especially on regard to hemispheric strokes. The treatment of massive cerebral infarctions is sometimes difficult, as some patients with high ICP do respond very poorly to the usual conservative management. None of these conservative methods has been