Delayed rise in intracranial pressure in patients with head injury

Abstract

This prospective study was done on patients of severe and moderate head injury (GCS<=12) admitted in the department of neurosurgery over a two month period to evaluate the significance of delayed rise in intracranial pressure in patients with severe and moderate head injury and to see for any correlation with CT head findings and neurological outcome. Patients who presented within 8 hours of injury and in whom intracranial pressure (ICP) monitoring was done were enrolled in the study. Patients were managed as per departmental protocols. Based on serial intracranial pressure patients were divided in three groups: Initial high ICP group (IHICP group) consisting of patients with initial high ICP value of >20 cm H₂O. Delayed high ICP group (DHICP group) consisting of patients with initial normal ICP <20 cmH2O with a delayed rise after a variable period (24-96 hrs), & normal ICP group (NICP group) comprising patients with persistently normal ICP of < 20 cmH₂O. A total of 21 patients were enrolled in the study. All were males with a mean age of 33 years. 17 (80.9%) patients had severe head injury (GCS d” 8) and 4 (19%) patients had moderate head injury (GCS 9 e” 12). There were five patients in IHICP group with a mean initial ICP of 35 cmH2O. Three (60%) patients in this group had effaced cisterns on CT whereas remaining two had grossly normal CT scans. All patients in this group were operated within 24 hours of injury and had excellent recovery with a mean GOS of 3.4. There were six patients in DHICP group with a mean initial ICP of 12 cmH2O. Four (66%) patients had effaced cisterns on initial CT and two had grossly normal CT scans. Mean ICP rose to 30 cmH2O (range 21–40 cmH2O) over a mean period of 66 hours (range 24–192 hours). All patients in this group were also operated. The mortality in this group was 50% (n=3) with mean GOS of 2. NICP group had 10 patients with mean ICP value of 13 cmH2O. Eight (80%) of these patients had normal CT Scans whereas two patients had effaced cisterns on initial CT. All patients in this group were managed conservatively with good recovery (mean GOS3.2). Patients of head injury with effaced cisterns on CT head and delayed rise in ICP had the worst outcome in our study. This the first study of its kind showing correlation between delayed rise in ICP and outcome. More studies are warranted to assess whether early surgery in this group of patients could improve outcome.

Keywords

Complications - Head injury - Intracranial pressure - ICP monitoring

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