Acta clinica Croatica, Vol. 39 No. 3, 2000.
Other
Disproportion Between ICP-CPP Data and Neurologic Findings in a Patient with Severe Head Trauma: Case Report
Mladen Novkoski
Aleksandar Gopčvić
Mijo Kelečić
Žljko Ivanec
Darko Bedek
Mladen Perić
Abstract
A 48-year-old man with relative hepatic impairment, thrombocytopenia and chronic alcoholism was admitted to intensive care unit six hours after head trauma. Computed tomography (CT) scan at admission indicated cerebral edema and subdural hematoma. Glasgow Coma Score (GCS) was 5, and his pupils were 4 mm in diameter without response. Decompression craniotomy with evacuation of hematoma was performed, and a ventricular catheter was introduced for intracranial pressure (ICP) monitoring. After the operation, there was no change in the neurologic status. ICP/CPP and jugular vein oxygen saturation (SvjO2) were continuously monitored and data were collected in hour-to-hour manner. Therapeutic goal was to optimize ICP and cerebral perfusion pressure (CPP) in accordance with the Guidelines for the Management of Severe Head Injury. Mannitol and barbiturates were not used in therapeutic procedures. Normocapnic values of PCO2 were maintained. During the first six hours postoperatively, the patient was stabilized hematologically and hemodynamically. At 24 hours postoperatively, there was no improvement in the neurologic status in spite of optimal values of ICP/CPP and SvjO2: GCS 5, pupils 4 mm with no response. The reason for this was detected on 24-hour CT scan, which revealed thalamic and pontine hemorrhage (mesencephalon lesion) with ischemia in the occipital region.
Keywords
Brain injuries, complications; Brain injuries, diagnosis; Predictive value of tests; Hematoma, complications; Intensive care, methods; Case report
Hrčak ID:
14971
URI
Publication date:
1.9.2000.
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