Intracranial Hemorrhage (ICH)

Not all head bleeds are the same - William Shyy MD and Debbie Yi Madhok MD

Intracranial Hemorrhage (ICH)

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Update on the ED Management of Intracranial Hemorrhage: Not All Head Bleeds Are the Same

Robust and comprehensive studies now support specific management guidelines for patients presenting with different intracranial hemorrhages (ICH).

Primary Intracranial Hemorrhages

Primary ICHs include both intraventricular and intraparenchymal bleeds. The majority are due to severe hypertension and are localized to the cerebellum, brainstem, and midbrain. Other etiologies include aneurysm and tumor. Up to 30% of these cases expand within the first 3 hours of onset, which is why treatment guidelines include a systolic blood pressure (SBP) goal of <140-180 mmHg. This is often achieved with an IV infusion of a vasodilator, such as nicardipine or nitroprusside.…

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 Update on the ED Management of Intracranial Hemorrhage: Not All Head Bleeds Are the Same

Robust and comprehensive studies now support specific management guidelines for patients presenting with different intracranial hemorrhages (ICH). From the Emergency Department perspective, the primary dilemmas involve specific blood pressure goals and whether seizure prophylaxis with phenytoin is necessary.

SAEM

All intracranial hemorrhages (ICH) share some classic clinical features. Common presenting symptoms include headache, nausea, vomiting, confusion, somnolence, or seizure. There is a wide clinical spectrum: patients may be alert and conversant, or moribund. In elderly, alcoholic, and anticoagulated patients, even minor head trauma can result in devastating intracranial bleeding. Despite these commonalities, there can be differences in the presentation of the four types of ICH,

Traumatic Brain Injury (TBI)

TBI is one of the leading causes of mortality and morbidity following trauma. Since younger patients are often involved, this causes a large person-year burden of morbidity.

SAEM

All intracranial hemorrhages (ICH) share some classic clinical features. Common presenting symptoms include headache, nausea, vomiting, confusion, somnolence, or seizure. There is a wide clinical spectrum: patients may be alert and conversant, or moribund. In elderly, alcoholic, and anticoagulated patients, even minor head trauma can result in devastating intracranial bleeding.

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