Intracranial Pressure Soon After Hemicraniectomy in Malignant Middle Cerebral Artery Infarction

Journal of Intensive Care Medicine
Sang-Beom JeonJong S Kim

Abstract

Decompressive hemicraniectomy reduces secondary brain injury related to brain edema and increased intracranial pressure (ICP) in patients with malignant middle cerebral artery infarction (MMI). However, a substantial proportion of patients still die despite hemicraniectomy due to refractory brain swelling. We aim to investigate whether ICP measured immediately after hemicraniectomy may indicate decompression effects and predict survival in patients with MMI. We included 25 patients with MMI who underwent ICP monitoring and brain computed tomography within the first hour of hemicraniectomy. Midline shifts were measured as radiological surrogates of decompression. The Glasgow Coma Scale and pupillary enlargements during the first day after hemicraniectomy were assessed as clinical surrogates of decompression. Long-term survival status at 6 months was used as the final outcome. We analyzed the relationships between early ICP and findings of midline shift, Glasgow Coma Scale, pupillary enlargement, and survival. Initial ICP was correlated with mean ICP ( P < .001) and maximal ICP ( P < .001) during the first postoperative day. Intracranial pressure was associated with midline shifts ( P = .009), lower Glasgow Coma Scale scores ( P ...Continue Reading

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Citations

Jul 26, 2019·BMJ : British Medical Journal·Shannon M FernandoJeffrey J Perry
Dec 5, 2020·Stroke; a Journal of Cerebral Circulation·Silvia Hernández-DuránChristian von der Brelie
Dec 1, 2020·Journal of Neurosurgical Sciences·Friedrich MroskPeter Vajkoczy
Aug 21, 2021·European Stroke Journal·H Bart van der WorpGötz Thomalla

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sedation

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SPSS
PetaVision

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