Masami Yano

Intracranial Pressure in Head-injured Patients with Various Intracranial Lesions Is Identical throughout the Supratentorial Intracranial Compartment

Subarachnoid pressure was measured by bifrontal catheterization to obtain concurrent comparative intracranial pressures (ICPs). These ICPs were compared in 15 head-injured patients who had differences in the pathological processes affecting the right and left hemispheres. ICPs in these patients ranged from -3 to 130 mm Hg, but no difference was found in the concurrent comparative ICPs. These findings suggest that the supratentorial space can generally be considered as one compartment regardless of the differences in types of intracranial lesions.

The Value of Intracranial Pressure (ICP) Measurement in Acute Severe Head Injury Showing Diffuse Cerebral Swelling

Computerized tomography (CT) is widely used today for the diagnosis and management of patients with severe head injury (1, 2, 4, 8, 9). It has recently been shown that diffuse cerebral swelling can be detected by CT in the early stages of severe acute head injury (1, 4, 8, 9). To our knowledge, there have not been many studies dealing with monitoring of raised intracranial pressure (ICP) caused by diffuse cerebral swelling (1, 4, 9). In this study, we determined the diagnostic value of ICP measurement in patients showing diffuse cerebral swelling.

Useful ICP Monitoring with Subarachnoid Catheter Method in Severe Head Injuries

ICP in 233 patients with severe head injuries was monitored utilizing a subarachnoid catheter technique. The relationships between initial ICP and GCS, between initial ICP and GOS, between maximal ICP and GCS, and between maximal ICP and GOS were examined statistically. The correlation was significant in each case, but particularly so between maximal ICP and GOS. Thus morbidity and mortality may be dependent upon maximal ICP. Catheterization of the subarachnoid space presents little difficulty using a Tuohy needle for epidural anesthesia as an introducer. Though the catheter is very fine (1.0 mm in outer diameter), failure of waveform occurred in only 2.1% of all patients. The procedure can be easily performed at the bedside, is safe, inexpensive, and useful for the management of severe head injuries. Meningitis was recognized in 4.7% of all patients.

The Outcome with Barbiturate Therapy in Severe Head Injuries

Barbiturate rapidly lowers intracranial pressure (ICP) and this may prevent potential secondary cerebral ischemic insults. A number of reports have described the use of high dose barbiturate in head injuries with or without assessment of effect on outcome (Saul and Ducker 1982; Marshall et al. 1979; Nordby et al. 1984). In order to define barbiturate effect in severe head injuries, a 3-year comparative study of high dose barbiturate therapy was undertaken (Yano et al. 1985).

Clinical Analysis of Intracranial Hypertension in Severe Head Injury

It has been emphasized that intensive care is necessary in the management of severe head trauma. Diagnosis and treatment of elevated intracranial pressure (ICP) is especially important. ICP monitoring is useful as an early warning system and for evaluation of therapeutic effects.