Large hemispheric infarction, deterioration, and intracranial pressure

Area of Science:

• Neurology
• Neurosurgery
• Critical Care Medicine

Background:

• Large hemispheric infarction with edema (LHIE) can cause severe neurologic deterioration.
• Therapies to decrease intracranial pressure (ICP) are common but may worsen mass effect.
• The role of elevated ICP as a cause of initial deterioration in LHIE is unclear.

Purpose of the Study:

• To determine if elevated ICP is a frequent cause of neurologic deterioration in patients with LHIE.
• To measure initial ICP and cerebral perfusion pressure (CPP) in patients experiencing stupor from LHIE.

Main Methods:

• Nineteen patients with LHIE who deteriorated to stupor were monitored for ICP and CPP before any ICP-lowering therapy.
• Exclusion criteria included metabolic issues, medication side effects, infection, and seizures.
• ICP was measured using Camino monitors, ventriculostomy, or epidural sensors.

Main Results:

• Only 26.3% of patients (5/19) showed elevated ICP (> 15 mm Hg).
• The mean initial ICP was 13.4 +/- 10 mm Hg.
• Only 10.5% of patients (2/19) had diminished CPP (< 55 mm Hg), with a mean CPP of 74.9 +/- 14 mm Hg.

Conclusions:

• Globally elevated ICP is not a common cause of initial neurologic deterioration in LHIE.
• The mass effect of LHIE may not frequently lead to significant ICP elevation at the onset of deterioration.