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Chapter 13 - Acute Treatment of Intracerebral Haemorrhage

from Part IV - Acute Treatment of Haemorrhagic Stroke

Published online by Cambridge University Press:  15 December 2020

By
Tom Moullaali ,
Rustam Al-Shahi Salman  and
Craig Anderson
Edited by
Jeffrey L. Saver  and
Graeme J. Hankey
Jeffrey L. Saver
Affiliation:
David Geffen School of Medicine, University of Ca
Graeme J. Hankey
Affiliation:
University of Western Australia, Perth
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Summary

Acute non-traumatic intracerebral haemorrhage (ICH) has a poor prognosis and is the least treatable form of acute stroke.Although less common than acute ischaemic stroke, ICH causes greater premature loss of productive life years on a global scale due to its predilection to affect people at younger ages with devastating consequences.Prognosis from ICH is related to location, initial volume and speed of expansion of the haematoma, and associated intraventricular haemorrhage. Care in a specialised stroke or neurointensive care unit improves outcome. Surgical haematoma evacuation should be pursued as for patients with cerebellar haemorrhage with neurologic deterioration, hydrocephalus, orsd brainstem compression. Haematoma evacuation may be considered, as a life-saving measure, in patients with coma or large haematoma with mass effect.Minimally-invasive surgery in stable patients is of uncertain benefit and is being evaluated in RCTs.Clinicians should not routinely use haemostatic therapies where there is no evidence of coagulopathy or anticoagulant use.When coagulopathy is present, early corrective measures should be taken. Early moderate intensity BP lowering to a systolic BP target of 140 mmHg is reasonable.Medical therapies to reduce mass effect and intracranial pressure should not be used routinely, but hyperventilation and hypertonic saline or colloidal osmotic agents are reasonable in patients with imminent herniation as a bridge to definitive neurosurgical intervention. Corticosteroids should be avoided.Novel neuroprotective approaches hold promise.

Keywords

Intracerebral hemorrhageintraventricular hemorrhageprognosishydrocephalusherniationhematoma evacuationblood pressure loweringcoagulopathyhyperventilationhypertonic saline.managementtreatmen
Type
Chapter
Information
Stroke Prevention and Treatment
An Evidence-based Approach
 , pp. 239 - 259
Publisher: Cambridge University Press
Print publication year: 2020

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