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23 - Intracerebral haemorrhage

from Section 4 - Neurointensive care

Published online by Cambridge University Press:  05 December 2011

By
Fred Rincon  and
Stephan A. Mayer
Edited by
Basil F. Matta ,
David K. Menon  and
Martin Smith
Basil F. Matta
Affiliation:
Addenbrooke's Hospital, Cambridge
David K. Menon
Affiliation:
Addenbrooke's Hospital, Cambridge
Martin Smith
Affiliation:
Department of Neuroanaesthesia and Neurocritical Care, the National Hospital for Neurology and Neurosurgery, University College London Hospitals
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Summary

Spontaneous intracerebral haemorrhage (ICH) is the most devastating type of stroke, and is a leading cause of disability among adults. Haematoma expansion is an important cause of early neurological deterioration, and the volume of the haematoma is a powerful predictor of outcome after primary ICH. MRI techniques such as gradient-echo and susceptibility weighted imaging are highly sensitive for the diagnosis of ICH and may identify distant microhaemorrhages that suggest cerebral amyloid angiopathy (CAA) as the cause of ICH. Standard measurements in the intensive care unit (ICU) indicated for the optimal monitoring of ICH patients include invasive arterial blood pressure and ventricular drainage or placement of an intracranial pressure (ICP) monitor for comatose patients. Craniotomy is the most-studied intervention for ICH. A pilot study of ultra-early craniotomy performed within 6 h of ICH onset was stopped due to problems with haemostasis in the surgical bed.

Keywords

anaesthesiaawake craniotomyhaemodynamic stabilitypre-operative assessmentsupratentorial surgeryneurological assessmentintracranial tumours
Type
Chapter
Information
Core Topics in Neuroanaesthesia and Neurointensive Care , pp. 359 - 368
Publisher: Cambridge University Press
Print publication year: 2011

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