Feature Film - Is There Evidence Behind the Mangement of Spontaneous Intracerebral Hemorrhage?

 
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Overview

  • Intracerebral hemorrhage (ICH) accounts for 10-15% of all strokes and affects ~65,000 patients annually in the US. Mortality ranges from 35-52% and only 20% are functionally independent at six months.

  • Once the diagnosis has been made, the emergency provider should focus on preventing hematoma expansion, optimizing cerebral perfusion and ensuring the best environment for recovery.

Here are the Cliff Notes to Dr. Siket’s Lecture Below

  • The ‘CTA Spot Sign’ is one predictor of early expansion and poor outcome.

  • Warfarin and novel oral anticoagulant associated ICH should be reversed early and aggressively.

  • Reversing antiplatelet medications is not recommended.

  • Surgery is indicated for most cerebellar ICH.

  • Intraventricular hemorrhage and hydrocephalus should be treated with placement of an external ventricular drain.

  • Aggressive BP lowering is safe, but has not been shown to be beneficial.

  • Close management of glucose, temperature, and dysphagia impacts survival.

  • Routine seizure prophylaxis is not supported by evidence.

  • In severe ICH it is reasonable to trial aggressive medical management for 1-2 days in accordance with family wishes.

 

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Matthew S. Siket, MD, MS

Assistant Professor of Emergency Medicine

Warren Alpert Medical School of Brown University

Providence, RI

 

 

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