Warning: file_get_contents(https://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=28959487
&cmd=llinks): Failed to open stream: HTTP request failed! HTTP/1.1 429 Too Many Requests
in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 215
Deprecated: Implicit conversion from float 217.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534
Deprecated: Implicit conversion from float 217.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534
Warning: imagejpeg(C:\Inetpub\vhosts\kidney.de\httpdocs\phplern\28959487
.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Stroke+Vasc+Neurol
2017 ; 2
(1
): 21-29
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Current management of spontaneous intracerebral haemorrhage
#MMPMID28959487
Dastur CK
; Yu W
Stroke Vasc Neurol
2017[Mar]; 2
(1
): 21-29
PMID28959487
show ga
Intracerebral haemorrhage (ICH) is the most devastating and disabling type of
stroke. Uncontrolled hypertension (HTN) is the most common cause of spontaneous
ICH. Recent advances in neuroimaging, organised stroke care, dedicated
Neuro-ICUs, medical and surgical management have improved the management of ICH.
Early airway protection, control of malignant HTN, urgent reversal of
coagulopathy and surgical intervention may increase the chance of survival for
patients with severe ICH. Intensive lowering of systolic blood pressure to
<140?mm?Hg is proven safe by two recent randomised trials. Transfusion of
platelets in patients on antiplatelet therapy is not indicated unless the patient
is scheduled for surgical evacuation of haematoma. In patients with small
haematoma without significant mass effect, there is no indication for routine use
of mannitol or hypertonic saline (HTS). However, for patients with large ICH
(volume > 30?cbic centmetre) or symptomatic perihaematoma oedema, it may be
beneficial to keep serum sodium level at 140-150?mEq/L for 7-10?days to minimise
oedema expansion and mass effect. Mannitol and HTS can be used emergently for
worsening cerebral oedema, elevated intracranial pressure (ICP) or pending
herniation. HTS should be administered via central line as continuous infusion
(3%) or bolus (23.4%). Ventriculostomy is indicated for patients with severe
intraventricular haemorrhage, hydrocephalus or elevated ICP. Patients with large
cerebellar or temporal ICH may benefit from emergent haematoma evacuation. It is
important to start intermittent pneumatic compression devices at the time of
admission and subcutaneous unfractionated heparin in stable patients within
48?hours of admission for prophylaxis of venous thromboembolism. There is no
benefit for seizure prophylaxis or aggressive management of fever or
hyperglycaemia. Early aggressive comprehensive care may improve survival and
functional recovery.
free
free
free
