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Critical Care Management of Acute Intracerebral Hemorrhage

  • Critical Care Neurology
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

Intracerebral hemorrhage is a medical emergency. It is the most deadly and disabling form of stroke, and no individual therapy has been demonstrated to improve outcome. However, it appears that aggressive medical care in general, and management by neuroscience specialists in particular, offers substantial benefit. Therefore, providing the best supportive care based on currently available evidence may well improve outcomes. Airway management and management of blood pressure aimed at maximizing cerebral perfusion while minimizing ongoing bleeding, as well as rapid reversal of anticoagulation, are likely to be important in the early phase. Additionally, efforts should be undertaken to provide careful glucose management and temperature management and to maximize cerebral perfusion pressure. Selected patients are likely to benefit from external ventricular drainage or even hematoma evacuation. Except in rare circumstances, most patients should be managed in a neuroscience intensive care unit during the acute phase. Some patients appear to have no reasonable likelihood of recovery and can be considered for limitations of care such as Do Not Resuscitate orders or Comfort Measures Only orders. However, it can be difficult to accurately predict long-term outcome in the acute phase; formal prognostic tools should be used to offer information to patients and their families. After the hemorrhage has stabilized, efforts to minimize complications include thromboembolism prophylaxis, physical therapy, and acute rehabilitation.

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Conflicts of Interest: J. Goldstein: Consulting fees and travel expenses from CSL Behring; A. Gilson: None.

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Correspondence to Joshua N. Goldstein MD, PhD.

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Goldstein, J.N., Gilson, A.J. Critical Care Management of Acute Intracerebral Hemorrhage. Curr Treat Options Neurol 13, 204–216 (2011). https://doi.org/10.1007/s11940-010-0109-2

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