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Temporal dynamics of ICP, PRx, CPP, and CPPopt in relation to functional outcome in spontaneous cerebellar hemorrhage

Rozerin Kevci1, Anders Hånell2, Hilin Sida2

  • 1Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden. rozerin.kevci@uu.se.

Critical Care (London, England)
|June 11, 2026
PubMed

Insights

Spontaneous cerebellar hemorrhage (sCH) monitoring shows higher cerebral perfusion pressure (CPP) may improve outcomes. Intracranial pressure (ICP) and CPP deviation (ΔCPPopt) are key prognostic indicators in sCH patients.

Area of Science:

  • Neurocritical care
  • Cerebrovascular physiology
  • Intensive monitoring

Background:

  • Spontaneous cerebellar hemorrhage (sCH) is a critical condition due to posterior fossa anatomy.
  • Cerebral physiological dynamics and their link to outcomes in sCH are not well understood.

Purpose of the Study:

  • To investigate the temporal dynamics of intracranial pressure (ICP), pressure reactivity index (PRx), cerebral perfusion pressure (CPP), and CPP deviation from optimal (ΔCPPopt) in sCH.
  • To analyze the association of these variables with functional outcomes in sCH patients.

Main Methods:

  • Retrospective analysis of 94 adult sCH patients from a neurointensive care unit.
  • Utilized high-resolution monitoring data to analyze physiological variables and their association with Glasgow Outcome Scale at discharge (GODS).
  • Employed outcome heatmaps and statistical analyses of monitoring time within/outside specific thresholds.

Main Results:

  • Higher CPP (>80 mmHg) correlated with favorable outcomes, while lower CPP (<60 mmHg) was associated with worse outcomes (p=0.02).
  • Negative ΔCPPopt, particularly with elevated PRx, correlated with lower GODS (p=0.04).
  • Trends suggested unfavorable outcomes with ICP >15 mmHg and elevated PRx, though not statistically significant.

Conclusions:

  • Cerebral physiological monitoring offers crucial prognostic insights for sCH.
  • Optimal CPP targets in sCH may differ from supratentorial injuries, potentially benefiting from higher CPP.
  • Further multi-center studies are needed to establish sCH-specific monitoring targets for ICP, CPP, and ΔCPPopt.
Abstract

Keywords:
Cerebral perfusion pressureCerebral pressure autoregulationIntracranial pressureNeurointensive careOutcomeSpontaneous cerebellar hemorrhage

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