HYPERTENSIVE HEMORRHAGIC STROKE;

Abstract

Objectives: The aim of our study is to evaluate the use of intracranial pressuremonitoring as a predictor of neurological deterioration in patients with hemorrhagic stroke andevaluate the relationship of continuous intracranial pressure monitoring with warning signsof brain herniation and hematoma enlargement in our setup. Study Design: Randomizedcontrolled trial. Period: 02 years duration from June 2014 to June 2016. Setting: Tertiary CareHospital in Karachi Pakistan. Method: Patients in group A had continuous monitoring of theintracranial pressures by having an implant device placed under general anesthesia. Bothgroups 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 every8 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 theonset of initial stroke. While in the control group pressures were monitored using neurologicalsigns and clinical measurements, and the dose of mannitol was adjusted accordingly. Theoutcome was assessed within 1 month duration from the onset of hemorrhagic stroke, and theparameters used were hematoma progression and herniation of the brain. Results: The patientpopulation consisted of n= 100 patients, who presented to our hospital with a primary diagnosisof hemorrhagic stroke, as confirmed by CT scan. The patient population was divided into twogroups using a random number generator, group A consisted of the patients who underwentintracranial pressure monitoring and had n= 52 patients, while group B consisted of the controlgroup (no objective ICP measurement) and had n= 48 patients in the group. The incidence ofenlargement 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 theICP monitoring group and n= 10 (20.833%) developed it in the control group respectively. Wefound that the mortality rate in our study population was n= 4 (7.69%) in ICP monitoring groupand n= 5 (10.41%) in the control group having a p value of 0.04, the neurological outcome in thetwo groups also had statistically significant differences, having a p value of 0.03. Conclusion: Inour study we found a lower incidence of secondary brain herniation in patients who underwentcontinuous intracranial pressure monitoring as compared to control group, furthermore thesepatients had better neurological outcomes.