Clinical observation of the time course of raised intracranial pressure after subarachnoid hemorrhage

Abstract

The time course of intracranial pressure (ICP) after subarachnoid hemorrhage (SAH) is not well known. This retrospective study was conducted to investigate the occurrence and the dynamic variation of raised ICP post-SAH. ICP was prospectively studied in 120 patients with SAH who were admitted to neurocritical care within 24 h of hemorrhage. Patients underwent continuous ICP monitoring for at least 7 days, unless they died. Clinical status on admission, radiographic tests, treatment details and neurological outcome on discharge were analyzed in relation to ICP. The highest daily mean ICP and the day when ICP reduced to normal levels were assessed. Of the 120 patients studied, 112 (93.3 %) encountered ICP elevation whilst in hospital. The daily mean ICP was higher in Hunt and Hess grades IV-V patients than grades I-III patients (P = 0.01). The elevated ICP remained at a higher level for the initial 3 days (grades I-III patients) or 4 days (grades IV-V patients), after which the pressure decreased towards normal levels. The in-patient mortality was significantly increased in the high ICP variability group (P = 0.001), which was divided by the cutoff point using receiver operating characteristic curve analysis. Raised ICP mainly occurs within 8 days post-SAH, especially the initial 3-4 days. Those highlight the need for earlier management of ICP after SAH.

High-Resolution Intracranial Pressure Burden and Outcome in Subarachnoid Hemorrhage

“…Episodes of HICP are more frequent in our cohort than in previous series, 10,12,13 which may reflect higher data granularity compared with previous series (median value >8000 data points per patient), the ICP system used, and the selection of a severe aSAH group. In the first week after aSAH, therapy for controlling ICP was needed in all patients, albeit with a reduction of its intensity during the first days.…”

“…12, 13 Patients with a highest mean ICP >20 mm Hg were significantly more likely to die. However, when considering a broader spectrum of negative outcomes (including death, vegetative state, and severe disability) at 6 month, ICP was not an independent predictor of an unfavorable outcome.…”

The change of plasma pituitary adenylate cyclase-activating polypeptide levels after aneurysmal subarachnoid hemorrhage

“…Thus, elevated intracranial pressure is very common after aSAH. Moreover, high intracranial pressure is associated with the severity of early brain injury and with mortality in patients with aSAH . However, in the current study, this group of patients did not undergo intracranial pressure monitoring and, therefore, the data about relationship between plasma PACAP levels and raised intracranial pressure was unavailable.…”

“…However, revealing the effects of nimodipine and ‘3H’ therapy on plasma PACAP levels may offer some information. Secondly, a recent report has shown that 93.3% patients with aSAH encounter intracranial pressure elevation while in hospital. Also, recently, another study has reported that eighty‐one percent of aSAH patients have at least one episode of high intracranial pressure.…”

“…However, in the current study, this group of patients did not undergo intracranial pressure monitoring and, therefore, the data about relationship between plasma PACAP levels and raised intracranial pressure was unavailable. Due to the close association between elevated intracranial pressure and injury severity and clinical outcome of aSAH , plasma PACAP levels were supposed to be associated with elevated intracranial pressure. However, this sort of relationship remains to be further studied.…”