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December 1985

In Favor of Intracranial Pressure Monitoring and Aggressive Therapy in Neurologic Practice

Author Affiliations

From the Department of Neurology, Neurological/Neurosurgical Intensive Care Unit, Massachusetts General Hospital, Boston.

Arch Neurol. 1985;42(12):1194-1195. doi:10.1001/archneur.1985.04060110076019

There are several lively controversies regarding intracranial pressure (ICP) in acute neurologic practice, including its meaning in cerebral hemorrhage, ischemic brain edema, Reye's syndrome, global anoxia, and viral encephalitis. The value of measuring ICP, different methods of treatment, and the benefits of aggressive therapy each have supporters and detractors. Many subsidiary questions also beg answers, such as how to select patients for monitoring, treatment tailored to the patient's measured ICP as opposed to blind therapy with mannitol and hyperventilation, the place of high-dose barbiturate therapy or craniectomy in patients who have failed medical therapy, and the use of steroids.

What is the neurologist, hampered by generations of passivity in therapeutics, to do? Monitor ICP or not? In my opinion, when this important problem is considered as a sequence of clinical problems, the answer is a compelling yes. My conclusions, based on personal experience and a biased reading of the

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