To the Editor.
—We appreciate the ideas expressed by Drs Duff and Katzin and apologize for misquoting the timing of ICP monitoring in the article by Duff et al,1 but we believe that our aggressive approach is supported by literature on the subject and personal experience. Many of the differences between our study and that of Duff et al were due to their comparison of medical with surgical therapy for cerebral hemorrhage and the fact that few of their patients were comatose. All of our patients were comatose, and we sought to demonstrate that persistently raised ICP was associated with a poor outcome.Our rationale for monitoring and treating raised ICP aggressively in patients with a hemorrhage is based on the following observations, which were mostly made in cases of head injuries: (1) ICP elevation indicates that the mechanisms accommodating an intracranial mass are decompensating, and, as it rises, there is less
Ropper AH, King RB. Intracranial Pressure Monitoring in Patients With Cerebral Hemorrhage. Arch Neurol. 1985;42(12):1134–1135. doi:10.1001/archneur.1985.04060110012006
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