Intracranial Pressure Monitoring in Hemorrhagic Transformation of Malignant Cerebral Infarct

腦內壓監測在惡性梗塞性腦中風及併出血性轉變的應用

10.30035/TCCM.201003.0007

曾嘉榮(Chia-Jung Tseng)；張志任(Chih-Zen Chang)；關暟麗(Aij-Lie Kwan)；洪純隆(Shen-Long Howng)

顱內壓 ； 複合式組織胞漿素原活化物 ； 惡性腦梗塞併出血性轉化 ； Intracranial pressure ； Recombinant tissue-type plasminogen activator ； Hemorrhagic transformation in cerebral infarct

重症醫學雜誌

11卷1期（2010 / 03 / 01）

45 - 53

英文

Owing to the benefit of intracranial pressure monitor (ICP-m) in cerebral trauma, ICP-m has never been directed into therapeutic arena in cerebral ischemia associated with hemorrhage transformation. This study is of interest to examine the flexibility of ICP-m in cases of malignant cerebral infarct (MCI) and hemorrhagic transformation (MCI-HT). Methods: Five cases were enrolled in this study retrospectively. Three cases are MCI-HT and two MCI. Among them, there are three males and two females with a mean age of 55±8 year old. All the patients received recombinant tissue-type plasminogen activator (rt-TPA) within 6 hrs after stroke and occurrence of hemorrhage transformation in three patients. Mapping cerebral perfusion under the critical condition of MCI is performed by ICP monitor and hemicraniectomy. Results: Deterioration and mortality associated with MCI and MCI-HT is relatively correlated to poststroke hyperglycemia, intractable hypertension and heart failure. Reflex the innate condition in close chamber injury, the parameters include ICP, intracranial temperature, and jugular blood sampling. ICP and serum sugar are proved to be reliable tool to guide following maneuvers. Conclusion: This study demonstrates ICP monitor offers a subjective parameter to adjust cerebral blood flow. Those with ICP more than 25mmHg are subjective to impending brain injury. People who have MCI-HT associated with ICP value above 30mmHg is a challenge in the critical medicine. Multiple factors such as BMI ＞25, diabetes mellitus, serum uric acid ＞8.0, hyperlipidemia and young age do not ascertain to compromise the outcome of MCI-HT. Iron gap is another promising tool in the MCI patients.

Owing to the benefit of intracranial pressure monitor (ICP-m) in cerebral trauma, ICP-m has never been directed into therapeutic arena in cerebral ischemia associated with hemorrhage transformation. This study is of interest to examine the flexibility of ICP-m in cases of malignant cerebral infarct (MCI) and hemorrhagic transformation (MCI-HT). Methods: Five cases were enrolled in this study retrospectively. Three cases are MCI-HT and two MCI. Among them, there are three males and two females with a mean age of 55±8 year old. All the patients received recombinant tissue-type plasminogen activator (rt-TPA) within 6 hrs after stroke and occurrence of hemorrhage transformation in three patients. Mapping cerebral perfusion under the critical condition of MCI is performed by ICP monitor and hemicraniectomy. Results: Deterioration and mortality associated with MCI and MCI-HT is relatively correlated to poststroke hyperglycemia, intractable hypertension and heart failure. Reflex the innate condition in close chamber injury, the parameters include ICP, intracranial temperature, and jugular blood sampling. ICP and serum sugar are proved to be reliable tool to guide following maneuvers. Conclusion: This study demonstrates ICP monitor offers a subjective parameter to adjust cerebral blood flow. Those with ICP more than 25mmHg are subjective to impending brain injury. People who have MCI-HT associated with ICP value above 30mmHg is a challenge in the critical medicine. Multiple factors such as BMI ＞25, diabetes mellitus, serum uric acid ＞8.0, hyperlipidemia and young age do not ascertain to compromise the outcome of MCI-HT. Iron gap is another promising tool in the MCI patients.