Intraventricular pressure monitoring in patients with thalamic and ganglionic hemorrhages

Abstract

In the present study, we have evaluated the use of intraventricular pressure catheters in thalamic and ganglionic hemorrhages. Ten patients admitted in our Emergency Department in Glasgow Coma Scale (GCS) equal or below 13 enrolled the study (at least one point should have been lost in the eye opening score to exclude purely aphasic patients that were fully alert). After a complete clinical and neurological evaluation, computed tomography scans were obtained and the volume of the hematomas, as well as presence or absence of hydrocephalus, were considered. Intraventricular pressure catheters connected in parallel to external derivation systems were implanted and patients were thereafter sent to the ICU. Patients that presented mass effect lesions with sustained increased ICP levels or clinical and neurological deterioration were submitted in addition, to the surgical evacuation of the hematomas. Clinical evolution, complications and the rehabilitation of the patients were recorded. Clinical outcome was assessed with the Glasgow Outcome Score. In all but three patients the initial intracranial pressure levels were bellow 20 mmHg (mean for all patients was 14.1 +/- 6.5 mmHg). Notwithstanding, these three patients were extremely difficult to treat. For this group of patients mortality was 100%. Among the patients that presented ICP levels bellow 20 mmHg, 04 developed hydrocephalus and 03 did not display ventricular dilation. As expected, the major benefits concerning the intraventricular pressure catheters connected in parallel with external derivation systems were observed in the group of patients that presented ICP levels bellow 20 mmHg and had hydrocephalus. Mild non-statistically significant correlations for all the three groups were achieved either when the initial GCS and ICP levels (r=-0.28, p=0.43) or when ICP levels and the volumes of the hematomas were compared (r=0.38, p=0.28). In addition, no significant correlations were observed concerning the final outcome of the patients and the variables previously evaluated.

A comparison of the Glasgow Coma Scale score to simplified alternative scores for the prediction of traumatic brain injury outcomes

“…1 In the 30 years since its introduction, the GCS has remained the cornerstone of initial traumatic brain injury evaluation by outof-hospital personnel, emergency physicians, trauma surgeons, and neurosurgeons. The GCS is believed to assist with communication, 2,15,16 is known to affect decisions about intervention, 14,[17][18][19][20] and is used in many circumstances to allocate resources. 3,8,[21][22][23] This ubiquitous neurologic score has been incorporated into a number of clinical decision rules 17,24,25 and other trauma scores [26][27][28][29] and has become the undisputed criterion standard for traumatic brain injury assessment.…”

A New Choice of Minimally Invasive Surgery for Intracerebral Hemorrhage in the Striatocapsular Regions Based on Computed Tomography Scans

“…In this group, the mixed type was the most common (19, 31.7%) and was followed by posteromiddle (13,21.7%), middle (12,20.0%), posterolateral (7, 11.7%), posteromedial (5, 8.3%), and anterior (4, 6.6%) types in decreasing order of frequency.…”

“…Some other scholars designed their classifications based on GCS score, intraventricular pressure, and hydrocephalus. 20,21 However, their classifications are unhelpful in choosing the surgical approach. To facilitate the surgical planning, we designed a modified system of 4 types and 3 subtypes of striatocapsular SICH based on the CT scans.…”

Critical Care and Emergency Medicine Neurology

“…These include patients with bilateral high-grade stenosis in ischemic stroke 29 as well as patients with intraventricular extension of hemorrhage in ICH. 30 …”