Intracranial pressure has been monitored in ten patients with Reye syndrome. All of the patients were comatose and all were treated with dexamethasone, mannitol, hyperventilation, and multiple exchange transfusions. Five of these children are alive and well; five died. In each case ICP monitoring allowed for immediate treatment and evaluation of the mode of therapy used to reduce elevated ICP. Exchange transfusions in all patients either reduced the increased ICP or made the pressure rises easier to manage. ICP is not always reflected by lumbar spinal fluid pressure or clinical state. In our hands, ICP monitoring has proved to be a safe technique for the investigation of the significance of raised ICP in the outcome of patients with Reye syndrome and of the effectiveness of a chosen therapy in reducing this pressure.
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