EPIDURAL ICP MONITORING AND ANTIEDEMA THE RAPY IN SEVERE HEMISPHERIC STROKE

Background and purpose: A permanent elevation of ICP after severe brai n injury for instance in subarachnoid or intracerebral hemorrhage or n eurotrauma is associated with a poor clinical outcome. Although increa singly being used in the intensive care of patients with elevated TCP, continous epidural ICP monitoring in ischemic stroke has not been fir mly established yet. Patients and methods: We prospectively evaluated the clinical course and outcome of patients with raised ICP due to spa ce occupying ischemic middle cerebral artery (MCA) infarction as seen in CT, who underwent continous ICP monitoring. Epidural ICP probes wer e inserted ipsilaterally (all patients) and contralaterally (additiona l in 7 patients) to the side of infarctation. Glasgow Coma and Scandin avian Stroke Scales (GCS and SSS) were obtained initially and in the f urther clinical course. All patients were subjected to a standardized treatment protocol for raised ICP. ICP values were correlated with cli nical presentation at the time point of deterioration, with outcome an d CT findings. Effectiveness of different treatment modalities to lowe r ICP were analyzed and discussed.