Fazal-ur Rehman, Sikander Idrees, Muhammad Hashim, Syed Maroof Hashmi.
Hypertensive Hemorrhagic Stroke; Effectiveness Of Intracranial Pressure Monitoring In Patients At A Tertiary Care Hospital In Karachi, Pakistan.
Professional Med J Jan ;24(8):1195-9.

Objectives: The aim of our study is to evaluate the use of intracranial pressure monitoring as a predictor of neurological deterioration in patients with hemorrhagic stroke and evaluate the relationship of continuous intracranial pressure monitoring with warning signs of brain herniation and hematoma enlargement in our setup. Study Design: Randomized controlled trial. Period: 02 years duration from June 2014 to June 2016. Setting: Tertiary Care Hospital in Karachi Pakistan. Method: Patients in group A had continuous monitoring of the intracranial pressures by having an implant device placed under general anesthesia. Both groups were given the required treatment as per guideline, including blood pressure reduction, diuretic and mannitol as per requirement. Both the groups were assessed clinically after every 8 hours in the initial three days and then every day till no deterioration were observed for 5 days (pupils, reflexes, extremity test etc) and a repeat CT scan was performed at 24 hours after the onset of initial stroke. While in the control group pressures were monitored using neurological signs and clinical measurements, and the dose of mannitol was adjusted accordingly. The outcome was assessed within 1 month duration from the onset of hemorrhagic stroke, and the parameters used were hematoma progression and herniation of the brain. Results: The patient population consisted of n= 100 patients, who presented to our hospital with a primary diagnosis of hemorrhagic stroke, as confirmed by CT scan. The patient population was divided into two groups using a random number generator, group A consisted of the patients who underwent intracranial pressure monitoring and had n= 52 patients, while group B consisted of the control group (no objective ICP measurement) and had n= 48 patients in the group. The incidence of enlargement of the hematoma in group A was n= 16 (30.76%) and in the control group was n= 18 (37.5%). And when it comes to brain herniation n= 6 (11.53%) patients developed it in the ICP monitoring group and n= 10 (20.833%) developed it in the control group respectively. We found that the mortality rate in our study population was n= 4 (7.69%) in ICP monitoring group and n= 5 (10.41%) in the control group having a p value of 0.04, the neurological outcome in the two groups also had statistically significant differences, having a p value of 0.03. Conclusion: In our study we found a lower incidence of secondary brain herniation in patients who underwent continuous intracranial pressure monitoring as compared to control group, furthermore these patients had better neurological outcomes.

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