[Neuroleptics and continuous measurement of intracranial pressure]

Neurosurgical patients, whether injured or not, have benefited in recent years from a new technique of supervision, measurement of thr intracranial pressure (ICP). Thus, measurement of a pressure figure and its course, gives precious information, both diagnostic and therapeutic. Various techniques of measurement are now proposed. We chose, for special reasons, measurement of the ICP within the ventricle. A catheter is introduced into the ventricle through a trephine hole. It is linked by a liquid column to a recording system (cathode oscilloscope, ink writer or magnetic tape). A slow inscriber permits continuous recording of the ICP for several days or even weeks. In view of the narrow dependency of the ICP on other physiological parameters, it seemed to us essential to record simultaneously 5 other parameters, the temperature, the blood pressure, the central venous pressure, the heart rate and the respiratory ventilation, by measurement of FeCO2 (capnography). Several forms of treatment have been proposed to bring down a raised ICP (greater than 15 mm Hg), e.g. osmotic diuresis, hyperventilation, corticosteroid therapy. Removal of CSF by ventriculalar catheter, sometimes permits one to pass over the critical period. It was in this background that we attempted to analyse the effect of neuroleptics on the ICP, without attempting to explain their mechanism of action. Our study was of 10 patients with cranial trauma, of both sexes, aged from 14 to 60 years. The intracranial pressure was measured within the ventricle and correlated with the other physiological parameters. When the ICP was normal, e.g. primary lesion of the brain stem, administration of neuroleptics such as chlorpromazine 100 mg IV/24 hours, or levopromazine 50 mg IV/24 hours, does not modify the value of the ICP. On the other hand, in the case of raised intracranial pressure due to contusion with cerebral oedema, for example, the administration of neuroleptic drugs seems to provide a very slight reduction in this pressure. It would be interesting to measure, at the same time as the ICP, the cerebral blood flow.