Early Signs of Elevated Intracranial Pressure on Computed Tomography Correlate With Measured Intracranial Pressure in the Intensive Care Unit and Six-Month Outcome After Moderate to Severe Traumatic Brain Injury

Harder, Tyler; Leary, Owen P.; Yang, Zhihui; Lucke‐Wold, Brandon; Liu, David D.; Still, Megan; Zhang, Miao; Yeatts, Sharon D.; Allen, Jason W.; Wright, David W.; Merck, Derek; Merck, Lisa H.

doi:10.1089/neu.2022.0433

Cited by 2 publications

(2 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Standardised fronto-parieto-temporal craniectomy with temporo-basal osteoclastic enlargement and opening of dura mater was performed as described earlier [ 17 ]. The indication for DC was based on the clinical and radiological signs related to increased intracranial pressure due to ICH [ 18 , 19 , 20 , 21 ]. Specifically, the indication was determined by analogy with the treatment of primary or secondary DC in TBI.…”

Section: Methodsmentioning

confidence: 99%

Outcome after Intracerebral Haemorrhage and Decompressive Craniectomy in Older Adults

Kapapa,

Jesuthasan,

Schiller

et al. 2024

Neurology International

View full text Add to dashboard Cite

Objective: There is a relationship between the incidence of spontaneous intracerebral haemorrhage (ICH) and age. The incidence increases with age. This study aims to facilitate the decision-making process in the treatment of ICH. It therefore investigated the outcome after ICH and decompressive craniectomy (DC) in older adults (>65 years of age). Methods: Retrospective, multicentre, descriptive observational study including only consecutive patients who received DC as the consequence of ICH. Additive evacuation of ICH was performed after the individual decision of the neurosurgeon. Besides demographic data, clinical outcomes both at discharge and 12 months after surgery were evaluated according to the Glasgow Outcome Scale (GOS). Patients were divided into age groups of ≤65 and >65 years and cohorts with favourable outcome (GOS IV–V) and unfavourable outcome (GOS I to III). Results: 56 patients were treated. Mean age was 53.3 (SD: 16.13) years. There were 41 (73.2%) patients aged ≤65 years and 15 (26.8%) patients aged >65 years. During hospital stay, 10 (24.4%) patients in the group of younger (≤65 years) and 5 (33.3%) in the group of older patients (>65 years) died. Mean time between ictus and surgery was 44.4 (SD: 70.79) hours for younger and 27.9 (SD: 41.71) hours for older patients. A disturbance of the pupillary function on admission occurred in 21 (51.2%) younger and 2 (13.3%) older patients (p = 0.014). Mean arterial pressure was 99.9 (SD: 17.00) mmHg for younger and 112.9 (21.80) mmHg in older patients. After 12 months, there was no significant difference in outcome between younger patients (≤65 years) and older patients (>65 years) after ICH and DC (p = 0.243). Nevertheless, in the group of younger patients (≤65 years), 9% had a very good and 15% had a good outcome. There was no good recovery in the group of older patients (>65 years). Conclusion: Patients >65 years of age treated with microsurgical haematoma evacuation and DC after ICH are likely to have a poor outcome. Furthermore, in the long term, only a few older adults have a good functional outcome with independence in daily life activities.

show abstract

Section: Methodsmentioning

confidence: 99%

Outcome after Intracerebral Haemorrhage and Decompressive Craniectomy in Older Adults

Kapapa,

Jesuthasan,

Schiller

et al. 2024

Neurology International

View full text Add to dashboard Cite

show abstract

“…The current recommendations regarding ICP monitoring are based on moderate-lowquality/weak evidence. ICP monitoring is recommended in patients with severe TBI who undergo surgical evacuation postoperatively if the patient meets any of the following conditions: preoperative GCS motor response score of 5 or less, preoperative hemodynamic instability, concerning signs on preoperative CT imaging (compressed basal cisterns, midline shift greater than 5 mm), preoperative anisocoria or bilateral mydriasis, intraoperative cerebral edema, or new lesions on postoperative CT imaging [32]. For nonoperative candidates, ICP monitors are recommended when the CT scan demonstrates signs of increased ICP, if serial neurological examination is not possible, and during extracranial surgery.…”

Section: Monitoringmentioning

confidence: 99%

Clinical Management in Traumatic Brain Injury

Yan,

Torpey,

Morrisroe

et al. 2024

Biomedicines

View full text Add to dashboard Cite

Traumatic brain injury is one of the leading causes of morbidity and mortality worldwide and is one of the major public healthcare burdens in the US, with millions of patients suffering from the traumatic brain injury itself (approximately 1.6 million/year) or its repercussions (2–6 million patients with disabilities). The severity of traumatic brain injury can range from mild transient neurological dysfunction or impairment to severe profound disability that leaves patients completely non-functional. Indications for treatment differ based on the injury’s severity, but one of the goals of early treatment is to prevent secondary brain injury. Hemodynamic stability, monitoring and treatment of intracranial pressure, maintenance of cerebral perfusion pressure, support of adequate oxygenation and ventilation, administration of hyperosmolar agents and/or sedatives, nutritional support, and seizure prophylaxis are the mainstays of medical treatment for severe traumatic brain injury. Surgical management options include decompressive craniectomy or cerebrospinal fluid drainage via the insertion of an external ventricular drain. Several emerging treatment modalities are being investigated, such as anti-excitotoxic agents, anti-ischemic and cerebral dysregulation agents, S100B protein, erythropoietin, endogenous neuroprotectors, anti-inflammatory agents, and stem cell and neuronal restoration agents, among others.

show abstract

Early Signs of Elevated Intracranial Pressure on Computed Tomography Correlate With Measured Intracranial Pressure in the Intensive Care Unit and Six-Month Outcome After Moderate to Severe Traumatic Brain Injury

Cited by 2 publications

References 44 publications

Outcome after Intracerebral Haemorrhage and Decompressive Craniectomy in Older Adults

Outcome after Intracerebral Haemorrhage and Decompressive Craniectomy in Older Adults

Clinical Management in Traumatic Brain Injury

Contact Info

Product

Resources

About