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Objective: This study aimed to assess the reliability of clinical features, noninvasive transcranial Doppler-related pulsatility index (PI) calculation, and optic nerve sheath diameter (ONSD) measured by ultrasound (US) and initial computed tomography (CT) scan (Marshall CT scan classification) in predicting the occurrence of early (<24 hours) high intracranial pressure (EHICP) (>20 mm Hg) after severe traumatic brain injury (TBI)., Methods: We conducted an observational prospective study in a level 1 trauma center. Patients were measured simultaneously for PI and US ONSD in the triage zone. Patients were categorized into 2 groups: those who had EHICP after TBI (EHICP+) and those who did not (EHICP-)., Results: Fifty-four patients were included; 32 were categorized as EHICP+ and 22 as EHICP-. PI >1.4 did not correlate with EHICP+ patients (69% vs. 46%, P = 0.09). US ONSD measurement was higher in the EHICP+ group (6.25; range, 6-6.95 vs. 5.7; range, 5.2-6.4; P = 0.005). The area under the receiver operating characteristic curve for US ONSD as a predictor of developing EHICP was 0.73 (95% confidence interval [CI], 0.59-0.86). CT ONSD measurement was higher in the EHICP+ group (6.71; range, 6.35-7.87 vs. 6.25; range, 5.8-6.93; P = 0.04). The area under the receiver operating characteristic curve for CT ONSD measurement as a predictor for EHICP+ was 0.67 (95% CI, 0.53-0.81). The diffuse injury III and IV categories in the Marshall CT scan classification were associated with the occurrence of EHICP (P = 0.004)., Conclusions: None of the clinical features or noninvasive tools assessed in this study enabled clinicians to strictly ascertain EHICP. Further studies are needed to establish their potential role before intracranial pressure probe insertion., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Acinetobacter baumannii meningitis and ventriculitis are difficult issues, because of the low diffusion of antibiotics in the cerebrospinal fluid and bacterial multidrug resistance. The presence of an infected intraventricular hematoma, constituting an equivalent of undrained abscess, may promote biofilm formation and failure of medical treatment., Case Description: In this case of ventriculostomy-related infection after ventricular hemorrhage, Acinetobacter baumannii was sensitive only to colistin and tigecycline. Despite a combination therapy involving intraventricular injections of colistin, we observed clinical and bacteriologic failure. Therefore, at day 4 of antibiotic therapy, we performed intraventricular fibrinolysis, which dissolved the clot, enabling sterilization of the cerebrospinal fluid after 48 hours., Conclusion: This clinical case suggests the usefulness of intraventricular fibrinolysis to lyse the clot and optimize the action of antibiotics., (Copyright © 2018 Elsevier Inc. All rights reserved.)