10 New Horizons for Hemorrhagic Stroke Critical Care Management

Ali H. Turkmani, Devi P. Patra, Evelyn L. Turcotte, Jose Omar Garcia, Chandan Krishna, and Bernard R. Bendok

Abstract

Intracerebral hemorrhage (ICH) is a hemorrhagic complication of the brain parenchyma that accounts for approximately 15 to 30% of all strokes and is the most deadly. Clinical features occur over the span of minutes to hours and include nausea, vomiting, severe headache, and alterations or loss of consciousness. Common mechanisms behind ICH are hypertension, vascular abnormalities, brain malignancies, certain medications (sympathomimetic, anticoagulant, etc.), and cerebral amyloid angiopathy. Accurate initial diagnosis by way of neuroimaging is crucial for finding the underlying etiology and for management of ICH. High mortality and morbidity is associated with a large volume of the hematoma and for patients on anticoagulation therapy. Appropriate medical management of ICH requires monitoring in a specialized care unit preferably a neuro-ICU. Medical management centers on reducing the elevated blood pressure, discontinuing and reversing any anticoagulant therapies, preventingearly expansion of the hematoma, treating the onset of seizures, and reducing the potential of hydrocephalus. In addition, it is important to be wary of making supportive treatment decisions based on the current prognostic models that are available.

Key words

intracerebral hemorrhage - stroke - critical care management

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