The Moscote-Janjua-Agrawal Rebound Risk Score: A Pragmatic Tool for Predicting Intracranial Hypertension Recurrence After Osmotherapy

Rebound intracranial hypertension (RIH) is an underdiagnosed but serious complication of hyperosmolar therapy in patients with acute brain injury.[1] Despite the need for osmotherapy with mannitol or hypertonic saline (HTS) for intracranial pressure (ICP) control, no consensus approach to identifying high-risk patients has developed.[1] [2] Osmotherapy using agents like mannitol or HTS continues to be an integral part in managing increased ICP in conditions such as traumatic brain injury, subarachnoid hemorrhage, and large-vessel stroke.[3] [4] [5] Useful as they are, sudden cessation or inappropriately rapid tapering of these agents results in RIH—a potentially life-threatening condition with ICP overshoot above its pretreatment baseline.[6] Although clinically important, RIH is little understood and underutilized at the bedside. Therapeutic tapering or extension is often achieved on empirical basis.[7] This short article suggests the following systematic approach to risk stratification of rebound through development of a Moscote-Janjua-Agrawal Rebound Risk Score (MJA-RIH) that condenses clinical and biochemical markers into a bedside instrument.

Publikationsverlauf

Artikel online veröffentlicht:
09. August 2025

• References

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