Intracranial pressure monitoring in comatose patients with cerebral hemorrhage
A. H. Ropper and R. B. King
Intracranial pressure (ICP) was measured continuously in ten consecutive
comatose patients with intracerebral hemorrhage. Eight hemorrhages were
ganglionic, one was thalamic, and one was lobar. The ICP at the time of
insertion of the monitoring device was below 20 mm Hg in four patients, 20
to 30 mm Hg in four, and above 30 mm Hg in two. Of the seven patients whose
ICP remained above 20 mm Hg despite aggressive medical therapy, three had
the clot removed surgically and all three survived, although one died of
sepsis a month later. The remaining four patients with uncontrolled ICP all
died of the syndrome of brain death. Of tht three patients whose ICP was
persistently below 20 mm Hg, one survived and two subsequently died of
sepsis after improving neurologically for the first week. Intracranial
pressure monitoring did not cause any morbidity. Raised ICP is related to
mortality in comatose patients with cerebral hemorrhage, and ICP monitoring
may be useful in guiding therapy, especially the timing and selection of
patients for surgery.
