neurologic disorders
Intracerebral Hemorrhage
Treatment of Intracerebral Hemorrhage
Supportive measures Control of modifiable risk factors Sometimes surgical evacuation (eg, for many cerebellar hematomas>3 cm) Treatment of intracerebral hemorrhage includes supportive measures and control of modifiable risk factors. Anticoagulants and antiplatelet medications are contraindicated. If patients have used anticoagulants, the effects are reversed when possible by giving fresh frozen plasma,prothrombin complex concentrate, vitamin K, or platelet transfusions as indicated. Antidotes for direct oral anticoagulants areidarucizumabfordabigatranand andexanet alfa forapixabanandrivaroxaban. As recommended by the American Heart Association and American Stroke Association 2022 guidelines, hypertension can be safely lowered to systolic blood pressure (BP) 140 mm Hg if systolic BP is between 150 mm Hg and 220 mm Hg and if acute antihypertensive treatment is not contraindicated ( Treatment reference ). If systolic BP is > 220 mm Hg, hypertension can be treated aggressively with a continuous IV infusion; in such cases, systolic BP must be monitored frequently. Cerebellar hemisphere hematomas that are>3 cm in diameter may cause midline shift or herniation, so surgical evacuation is often lifesaving. Early evacuation of large lobar cerebral hematomas may also be lifesaving, but rebleeding occurs frequently, sometimes increasing neurologic deficits. Early evacuation of deep cerebral hematomas is seldom indicated because surgical mortality is high and neurologic deficits are usually severe. Because the presence of hydrocephalus predicts a worse outcome after intracerebral hemorrhage, surgeons may place an external ventricular drain to rapidly decrease intracranial pressure. This procedure can be lifesaving. Antiseizure medications are not typically used prophylactically; they are used only if patients have had a seizure. 1.Greenberg SM, Ziai WC, Cordonnier C, et al: 2022 Guideline for the management of patients with spontaneous intracerebral hemorrhage: A guideline from the American Heart Association/American Stroke Association.Stroke53 (7):e282–e361, 2022. doi: 10.1161/STR.0000000000000407 Epub 2022 May 17. 