Real-time symptom reporting during elective intracranial pressure monitoring using an interactive handset

Determining whether symptoms are related to abnormal intracranial pressure (ICP) may prove challenging in some cases. We evaluated the utility of an in-house designed interactive handset which allows the real-time recording of symptoms during ICP monitoring.

Adult patients undergoing elective continuous ICP monitoring using the device to investigate symptoms between November 2013 and June 2015 were included in this retrospective observational cohort study. The device allowed the following symptoms to be recorded: mild, moderate and severe headache, visual disturbance and nausea. The corresponding ICP and ICP trend were also recorded.

Twenty seven patients underwent 29 episodes of ICP monitoring, reporting 383 symptoms (mild 18%, moderate 39%, severe 20% headaches, visual disturbance 15% and nausea 8%) over a median period of 48 hours (IQR 12). The median number of symptoms reported during each episode was 11 (IQR 11). The mean ICP associated with a symptom episode was 7mmHg (Range -10 to 45). Mild, moderate and severe headache complaints were associated with mean ICPs of 5 (-9 to 26), 6 (-10 to 35) and 14 (-10 to 45) mmHg respectively. The majority of complaints (68%) were reported during instances of normal ICP. Following monitoring, non-operative management was employed on 21 occasions (72%) including valve pressure adjustment on two occasions whilst surgical intervention was required on eight occasions (28%; two surgeries for under-drainage and six for over-drainage).

The device allows the clinician to accurately match a patient's symptoms with ICP to facilitate management decisions. In most instances, symptoms did not closely correlate with an abnormal ICP. By automating and standardising the collection of symptom data, this device may serve as an efficient adjunct when investigating patients with complex hydrocephalus.