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Medical Management of Patients with Subarachnoid or Intracranial Hemorrhage and Increased Intracranial Pressure

Intracranial hemorrhage requires an understanding of etiology and prompt management for an improved outcome. Intracranial hemorrhage is classified into four subcategories: epidural hemorrhage, subdural hemorrhage, subarachnoid hemorrhage, and intracerebral or intraparenchymal hemorrhage, according to the anatomical localization of the bleed. If it occurs in the space between the dura and the skull, then this is epidural hemorrhage, which usually traumatic and requires emergent surgical intervention. A subdural hematoma is localized between the dura and the arachnoid membrane. Usually, this entity occurs in elderly patients following trauma or a tear of a cortico-dural bridging vein. Hematoma evacuation in specific indications is the treatment of choice. Both epidural and subdural hematomas have a minimal role for medical intervention; thus this chapter focuses on the other two entities; subarachnoid hemorrhage and intracerebral hemorrhage. Studies have shown that early and specialized multidisciplinary management improves outcomes. This chapter discusses the etiology, presentation, and medical management of both subarachnoid and intracerebral hemorrhages.