Takara Hikaru
Rehabiltation, Naha City Hospital, Okinawa, JPN.
Cureus. 2025 Mar 18;17(3):e80783. doi: 10.7759/cureus.80783. eCollection 2025 Mar.
Rehabilitation and mobilization for patients with severe stroke, including postsurgical cases, are considered feasible if the intracranial pressure (ICP) remains below 20 mmHg. However, to the best of our knowledge, no study has evaluated real-time ICP changes during mobilization in patients with postoperative putaminal hemorrhage. In this case report, we detail the ICP fluctuations observed during mobilization in a patient with postoperative putaminal hemorrhage. A 47-year-old man was diagnosed with left putaminal hemorrhage and underwent emergency craniotomy for hematoma evacuation (day 1). Postoperatively, the patient was managed using continuous ICP monitoring. Mobilization (sitting on the edge of the bed) began on day 3, during which time the ICP was evaluated. The preintervention ICP was well controlled, ranging from 13 to 15 mmHg. During the transition to the sitting position, the patient attempted to rise on his own, leading to a transient ICP elevation exceeding 20 mmHg for approximately 20 seconds. While maintaining the sitting position, the ICP stabilized at approximately 5 mmHg without sustained elevation. The blood pressure, heart rate, and other vital signs remained stable throughout the intervention period. Our findings suggest that mobilization to a sitting position may be feasible without inducing sustained ICP elevation when ICP is well controlled.
对于重症中风患者，包括术后病例，若颅内压（ICP）维持在20 mmHg以下，康复和活动被认为是可行的。然而，据我们所知，尚无研究评估术后壳核出血患者活动期间的实时ICP变化。在本病例报告中，我们详细描述了一名术后壳核出血患者活动期间观察到的ICP波动情况。一名47岁男性被诊断为左侧壳核出血，并于第1天接受了紧急开颅血肿清除术。术后，对患者进行持续ICP监测。在第3天开始活动（坐在床边），在此期间评估ICP。干预前ICP控制良好，范围为13至15 mmHg。在转换至坐姿时，患者试图自行起身，导致ICP短暂升高超过20 mmHg约20秒。在保持坐姿时，ICP稳定在约5 mmHg，未持续升高。在整个干预期间，血压、心率和其他生命体征保持稳定。我们的研究结果表明，当ICP得到良好控制时，向坐姿的活动可能是可行的，不会引起ICP持续升高。
