Abstract
Intracerebral hemorrhage (ICH) consists of the rupture of an intracranial vessel with a subsequent overflow of blood directly to the brain parenchyma. It is the cause of 9–27% of all strokes. Neuroimaging, either brain computed tomography (CT) or magnetic resonance imaging (MRI), confirms the diagnosis and excludes other causes. Since hypertension is the most common cause of ICH, blood pressure management is a key point of clinical treatment. Another major risk factor is antithrombotic therapy. In patients with ICH using anticoagulants, quick identification of this condition and the reversal of the drug effect is of utmost importance. Despite significant progress in the clinical evaluation and management of ICH, the ideal surgical management and its efficacy are still unclear. The most studied surgical procedure in this context is decompressive craniotomy with/without hematoma drainage. It is mainly performed on large lobar hemorrhage or hematomas in the posterior fossa, which may lead to a quick clinical deterioration associated with brainstem herniation. The use of craniotomy for supratentorial hemorrhage drainage showed no overall benefit on major clinical trials; however, it may improve survival on selected cases. On the other hand, patients with cerebellar hematomas with acute neurological deterioration should be treated with an urgent suboccipital craniectomy and hematoma drainage according to major guidelines. Those with acute hydrocephalus due to intraventricular hemorrhage or large intraparenchymal hematoma with mass effect associated with impaired level of consciousness are eligible for urgent placement of an external ventricular drain (EVD), aiming to drain intraventricular blood and to maintain ICP < 20 mmHg and a CPP > 60 mmHg.
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de Andrade, J.B.C., Barros, F.C.D., Silva, G.S. (2021). Hemorrhagic Stroke. In: Figueiredo, E.G., Welling, L.C., Rabelo, N.N. (eds) Neurocritical Care for Neurosurgeons. Springer, Cham. https://doi.org/10.1007/978-3-030-66572-2_26
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