INTRACRANIAL PRESSURE IN REYE'S SYNDROME

Abstract

During the past 3 years the intracranial pressure(ICP)of 17 children with Reye's Syndrome(RS)has been monitored. The epidural monitor was placed in patients whose level of coma was III or deeper(Sherard Stages I-VI). The cerebrospinal fluid pressure or ICP was measured on 15 patients on admission to the hospital. The pressure was 200mm H2O or less in 7 patients and 300mm H2O or less in 13 patients. In survivors maximum ICP was recorded at 8-24 hours after admission and correlated with the level of coma. An ICP of 400-800 mm H2O was associated with coma level of IV or deeper. In one child the ICP was greater than 1300mm H2O. In 8 patients abrupt increases in ICP to 700mm HpO or greater occurred and preceded any clinical evidence of increasing ICP. These episodes lasted 20-30 minutes, and were treated with hyperventilation and/or mannitol. In 4 patients these episodes were repetitive, being separated by intervals of 2-12 hours. Most of our patients were admitted to the hospital during the early hours of their illness and were in Stage II or III coma. During this phase, the level of consciousness does not appear to be directly related to the ICP, however if the level of coma deepens during the next 24 hours after admission the ICP correlates with the stage of coma. Continuous ICP monitoring is essential for the optimal management of intracranial hypertension associated with RS and serves as an objective criteria for the administration of hyperosmolar agents in patients with coma Stage III or deeper.