From intracranial pressure to intracranial pressure wave-guided intensive care management of a patient with an aneurysmal subarachnoid haemorrhage

We report on a 65-year-old female with an aneurysmal subarachnoid hemorrhage (SAH) that was followed clinically, radiologically and electrophysiologically before and after converting from intracranial pressure (ICP)-guided to ICP wave-guided intensive care management. Intracranial pressure-guided management is aimed at keeping mean ICP < 15-20 mmHg, while ICP wave-guided management is aimed at keeping mean ICP wave amplitude < 5 mmHg. The aims of management were obtained by adjusting cerebrospinal fluid (CSF) draining volume from her external ventricular drain. No improvement was seen clinically or in cerebral magnetic resonance imaging (MRI) scans during the ICP-guided management. Clinical, MRI and neurophysiologic (electroencephalography and auditory evoked responses) improvements were obvious within 2 days after converting from ICP- to ICP wave-guided management. This case report describes how we used various ICP parameters to guide intensive care management of an aneurysmal SAH patient.