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Abstract

A 60-year-old female presented to the emergency department in a state of unconsciousness. She was found unconscious on the floor of her bedroom by her daughter in the morning. She had gone to bed at 9 pm the day before and was in a state of good health. She had hypertension for the previous 20 years and was on irregular medications. In the emergency department, she had a Glasgow Coma Scale (GCS) of E3V aphasia and M5 (GCS 8/10) and had weakness of the right half of the body. She had blood pressure of 220/100 mmHg, pulse of 60/min and regular breathing. Bilateral pupils were round, regular and reactive to light. She was started on injection labetalol and after her blood pressure stabilised was sent for computed tomography (CT) of the head with suspicion of stroke. CT of the head revealed a large intracerebral hematoma in the left putamen with an approximate volume of 24 mL with effacement of the sulci and lateral ventricle (Fig. 12.1). She was then managed in the ICU with regular BP monitoring with invasive arterial blood pressure monitoring and hourly monitoring of GCS. She was not on any anticoagulants and her coagulation profile was normal. She had an uneventful recovery, but with residual weakness of the right half of the body.

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References

  1. van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. 2010;9(2):167–76.

    Article  PubMed  Google Scholar 

  2. Morgenstern LB, Zahuranec DB, Sánchez BN, Becker KJ, Geraghty M, Hughes R, et al. Full medical support for intracerebral hemorrhage. Neurology. 2015;84(17):1739–44.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Chalela JA, Kidwell CS, Nentwich LM, Luby M, Butman JA, Demchuk AM, et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet. 2007;369(9558):293–8.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, et al. The ABCs of measuring intracerebral hemorrhage volumes. Stroke. 1996;27(8):1304–5.

    Article  CAS  PubMed  Google Scholar 

  5. Hemphill JC III, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001;32(4):891–7.

    Article  PubMed  Google Scholar 

  6. Greenberg SM, Ziai WC, Cordonnier C, Dowlatshahi D, Francis B, Goldstein JN, et al. 2022 guideline for the management of patients with spontaneous intracerebral hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke. 2022;53(7):e282–361.

    Article  CAS  PubMed  Google Scholar 

  7. Hemphill JC III, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46(7):2032–60.

    Article  PubMed  Google Scholar 

  8. Qureshi AI, Huang W, Lobanova I, Barsan WG, Hanley DF, Hsu CY, et al. Outcomes of intensive systolic blood pressure reduction in patients with intracerebral hemorrhage and excessively high initial systolic blood pressure: post hoc analysis of a randomized clinical trial. JAMA Neurol. 2020;77(11):1355–65.

    Article  PubMed  Google Scholar 

  9. Anderson CS, Heeley E, Huang Y, Wang J, Stapf C, Delcourt C, et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013;368(25):2355–65.

    Article  CAS  PubMed  Google Scholar 

  10. Hanley JP. Warfarin reversal. J Clin Pathol. 2004;57(11):1132–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Sarode R, Milling TJJ, Refaai MA, Mangione A, Schneider A, Durn BL, et al. Efficacy and safety of a 4-factor prothrombin complex concentrate in patients on vitamin K antagonists presenting with major bleeding: a randomized, plasma-controlled, phase IIIb study. Circulation. 2013;128(11):1234–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Guidelines on oral anticoagulation: third edition. Br J Haematol. 1998;101(2):374–87.

    Google Scholar 

  13. Schulman S, Bijsterveld NR. Anticoagulants and their reversal. Transfus Med Rev. 2007;21(1):37–48.

    Article  PubMed  Google Scholar 

  14. Hanley DF, Lane K, McBee N, Ziai W, Tuhrim S, Lees KR, et al. Thrombolytic removal of intraventricular haemorrhage in treatment of severe stroke: results of the randomised, multicentre, multiregion, placebo-controlled CLEAR III trial. Lancet. 2017;389(10069):603–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet. 2005;365(9457):387–97.

    Article  PubMed  Google Scholar 

  16. Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet. 2013;382(9890):397–408.

    Article  PubMed  PubMed Central  Google Scholar 

  17. De Herdt V, Dumont F, Hénon H, Derambure P, Vonck K, Leys D, et al. Early seizures in intracerebral hemorrhage: incidence, associated factors, and outcome. Neurology. 2011;77(20):1794–800.

    Article  PubMed  Google Scholar 

  18. Schwarz S, Häfner K, Aschoff A, Schwab S. Incidence and prognostic significance of fever following intracerebral hemorrhage. Neurology. 2000;54(2):354–61.

    Article  CAS  PubMed  Google Scholar 

  19. Lord AS, Karinja S, Lantigua H, Carpenter A, Schmidt JM, Claassen J, et al. Therapeutic temperature modulation for fever after intracerebral hemorrhage. Neurocrit Care. 2014;21(2):200–6.

    Article  PubMed  Google Scholar 

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Sedain, G., Sharma, S., Shrestha, G.S. (2024). Intracerebral Hemorrhage. In: Oli, K.K., Shrestha, G.S., Ojha, R., Pal, P.K., Pandey, S., Das, B. (eds) Case-based Approach to Common Neurological Disorders. Springer, Singapore. https://doi.org/10.1007/978-981-99-8676-7_12

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  • DOI: https://doi.org/10.1007/978-981-99-8676-7_12

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