Critical Matters Management of Intracerebral Hemorrhage
Nov 28, 2019
Dr. Sayona John, a neurointensivist at Rush Medical College, shares her expertise on managing intracerebral hemorrhage (ICH), the deadliest stroke type affecting millions. She highlights the critical importance of rapid diagnosis using CT scans and how blood pressure control can mitigate hematoma expansion. Discussions include distinguishing between hypertensive and amyloid-related bleeds, the role of anticoagulant reversal, and effective surgical interventions for cerebellar hemorrhages. Dr. John emphasizes a systems approach to timely care and the need for clear protocols.
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ICH Is Small Percentage, Big Impact
- Intracerebral hemorrhage (ICH) is 10–15% of strokes but causes disproportionately higher death and disability.
- Hypertension is the most common cause, so blood pressure control is primary prevention.
CT First, CTA Selectively
- Get an immediate noncontrast CT to distinguish hemorrhage from ischemia for any acute neurological deficit.
- Consider CT angiography in younger patients, atypical locations, or absent hypertension history to evaluate vascular lesions.
Location Suggests Etiology
- Location helps suggest cause: deep basal ganglia, thalamus, cerebellum, brainstem favor hypertensive ICH.
- Lobar hemorrhages and cortical microbleeds in older patients suggest cerebral amyloid angiopathy.