Document Detail


The acute management of intracerebral hemorrhage: a clinical review.
MedLine Citation:
PMID:  20332192     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Intracerebral hemorrhage (ICH) is a devastating disease with high rates of mortality and morbidity. The major risk factors for ICH include chronic arterial hypertension and oral anticoagulation. After the initial hemorrhage, hematoma expansion and perihematoma edema result in secondary brain damage and worsened outcome. A rapid onset of focal neurological deficit with clinical signs of increased intracranial pressure is strongly suggestive of a diagnosis of ICH, although cranial imaging is required to differentiate it from ischemic stroke. ICH is a medical emergency and initial management should focus on urgent stabilization of cardiorespiratory variables and treatment of intracranial complications. More than 90% of patients present with acute hypertension, and there is some evidence that acute arterial blood pressure reduction is safe and associated with slowed hematoma growth and reduced risk of early neurological deterioration. However, early optimism that outcome might be improved by the early administration of recombinant factor VIIa (rFVIIa) has not been substantiated by a large phase III study. ICH is the most feared complication of warfarin anticoagulation, and the need to arrest intracranial bleeding outweighs all other considerations. Treatment options for warfarin reversal include vitamin K, fresh frozen plasma, prothrombin complex concentrates, and rFVIIa. There is no evidence to guide the specific management of antiplatelet therapy-related ICH. With the exceptions of placement of a ventricular drain in patients with hydrocephalus and evacuation of a large posterior fossa hematoma, the timing and nature of other neurosurgical interventions is also controversial. There is substantial evidence that management of patients with ICH in a specialist neurointensive care unit, where treatment is directed toward monitoring and managing cardiorespiratory variables and intracranial pressure, is associated with improved outcomes. Attention must be given to fluid and glycemic management, minimizing the risk of ventilator-acquired pneumonia, fever control, provision of enteral nutrition, and thromboembolic prophylaxis. There is an increasing awareness that aggressive management in the acute phase can translate into improved outcomes after ICH.
Authors:
Justine Elliott; Martin Smith
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review     Date:  2010-03-23
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  110     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-26     Completed Date:  2010-05-13     Revised Date:  2014-02-19    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1419-27     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Anticoagulants / therapeutic use
Anticonvulsants / therapeutic use
Blood Glucose / metabolism
Blood Pressure / physiology
Cerebral Hemorrhage / diagnosis,  epidemiology,  physiopathology,  therapy*
Hemostatics / therapeutic use
Humans
Intensive Care
Neurosurgical Procedures
Platelet Aggregation Inhibitors / therapeutic use
Risk Factors
Grant Support
ID/Acronym/Agency:
G0701458//Medical Research Council
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Anticonvulsants; 0/Blood Glucose; 0/Hemostatics; 0/Platelet Aggregation Inhibitors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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