neurologic disorders
Intracerebral Hemorrhage
Key Points
With intracerebral hemorrhage, sudden, severe symptoms (eg, sudden severe headache, loss of consciousness, vomiting) are common, but headache may be absent or mild (particularly in older people), and small hemorrhages may mimic ischemic stroke. Do CT or MRI and a bedside glucose test immediately. Essential supportive care may include reversing anticoagulation and decreasing BP to 140 mm Hg if systolic BP is between 150 mm Hg and 220 mm Hg; if systolic BP is > 220 mm Hg, consider aggressively reducing BP by continuously infusingnicardipineIV. Avoid BP fluctuations, and maintain BP < 140 mm Hg, but not lower than 130 mm Hg. Consider surgical evacuation for large lobar cerebral hematomas and hematomas > 3 cm in a cerebellar hemisphere. Consider placing an external ventricular drain for select patients with signs of hydrocephalus and increased intracerebral pressure. 