HYPERTENSIVE HEMORRHAGIC STROKE;

EFFECTIVENESS OF INTRACRANIAL PRESSURE MONITORING IN PATIENTS AT A TERTIARY CARE HOSPITAL IN KARACHI, PAKISTAN

Abstract

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.