Is supratentorial pressure difference clinically relevant? Analysis of 55 consecutive cases by bilateral intracranial pressure monitoring

摘要

Objective: The purpose of this study is to explore the possibilities of an early warning system bynmeasuring intracranial pressure differences in order to prevent secondary insults to the injurednbrain.nMethods: Fifty-five cases with a Glasgow coma scale (GCS) score 8 or below who presented withnintracranial hypertension due to various intracranial pathologies underwent bilateral intraparenchymatousnintracranial pressure (ICP) monitorization in an attempt to find out the existence ofninterhemispheric pressure differences. ICP values were recorded every 30 minutes during thenfirst 24 hour interval. Patients were stratified into two groups as diffuse and focal according to thenmagnitude of their pathologies. Focal cases were also grouped according to lesion size and/ornmidline shift.nResults: ICP differences that necessitated changes in the treatment were found at different timenintervals in patients with focal lesions, but these did not reach statistical significance within thenwhole group (p.0.05). There were significant percentage differences between focal I and IIngroups in correlation with lesion side and non-lesion side within the first 4.5 hours (p,0.05).nThere was a significant difference within the first 3 hours between diffuse and focal II groupsn(p,0.05).nDiscussion: In patients with focal lesions, although more pronounced in focal II group, apparentnpressure differences between two hemispheres within the first hours of admission were found.nThese pressure differences were related to the volume of the intracranial pathology. ICPnmonitorization from the lesion side is reasonable as an early forewarning procedure and thisnmight prevent the development of secondary insults by providing the exact ICP values of thenpatients. [Neurol Res 2008; 30: 465–470]