Intracerebral Hemorrhage

ICH

  • Intracerebral hemorrhage (ICH) is the 2nd leading cause of stroke behind ischemic.
  • Most common causes of ICH are hypertension, trauma, vascular malformations, tumors, bleeding diatheses.
  • 3 mechanisms of injury from ICH: increased cranial pressure, herniation resulting in mass shift, and direct injury to brain parenchyma.
  • Risk factors include hypertension, old age, African-American ethnicity, high alcohol intake, anticoagulation.
  • Thalamic hemorrhage can present with hemisensory loss, hemiparesis, transient homonomyous hemianopsia, aphasia, and neglect
  • Management:
    • Medical Therapy
      • Admit to ICU for close monitoring
      • Assess airway and breathing
      • Reverse coagulopathies
      • Treat underlying sources of fever, want to maintain normothermia
      • Hyponatremia associated with worsening cerebral edema, consider Na goal of >140
      • Target MAP of 110 mmHg if no suspicion of elevated ICP as high blood pressure can worsen cerebral edema.
      • Hyperglycemia associated with worse outcomes, treat if glucose > 185 mg/dL
      • Prevention of DVT with pneumatic compression devices
    • Surgical Intervention: cerebellar hemorrhages > 3cm and deteriorating, brainstem compression, or hydrocephalus due to ventricular obstruction
  • Secondary Prevention: treating hypertension and cessation from smoking, alcohol, and drug use may reduce risk of recurrent ICH