Aspects of intracerebral hematomas - an update

Abstract

Advances in diagnosis, prognosis, pathophysiology, and treatment over the past few decades have significantly advanced our knowledge of ICH; however, much work still needs to be carried out. Future genetic and epidemiologic studies will help identify at-risk populations and hopefully allow for primary prevention. Randomized controlled studies focusing on novel therapeutics should help to minimize secondary injury and hopefully improve morbidity and mortality.

Introductory Chapter: An Introduction to Hypertension-Related Intracerebral Hematomas

“…There have been speculations about the etiology of the expansion, viz. whether there occur repeated small hemorrhages or there is a continuous oozing [9]. Expansion of an ICH generally follows the general 'rule of thumb,' and the larger the hematoma at presentation, the more likely it is to expand [10].…”

“…The long-term prognosis for the survivors is not very encouraging with less than 30% of patients being independent at 3 months of the ICH ictus [6]. The goals of management therefore include prevention of further brain injury by deterring hematoma expansion, restricting edema and to atempt recruiting the brain's plasticity to improve the rehabilitation outcome [9]. Prehospital management is vital and primarily consists of ventilator and cardiovascular support and transporting the patient to the nearest available stroke unit [9,13].…”

“…The goals of management therefore include prevention of further brain injury by deterring hematoma expansion, restricting edema and to atempt recruiting the brain's plasticity to improve the rehabilitation outcome [9]. Prehospital management is vital and primarily consists of ventilator and cardiovascular support and transporting the patient to the nearest available stroke unit [9,13]. Management at the emergency room (ER) consists of a thorough neurological assessment, management of elevated blood pressures and neuroradiological evaluation and may entail emergency procedures such as insertion of an external ventricular drain, monitoring ICP and its management and reversal of coagulopathy [13].…”

“…Early studies had failed to demonstrate any signiicant diference between conservative and surgical management of ICH [9]. There were also reports of poorer surgical outcome due to the trauma of surgery itself and a higher postoperative re-hemorrhage rate [7].…”

“…There were also reports of poorer surgical outcome due to the trauma of surgery itself and a higher postoperative re-hemorrhage rate [7]. There have been over a dozen randomized controlled trials, addressing the issue of the surgical management of ICH [9]. The surgical approach to the hematoma depends on the location and the depth of the hematoma and eloquence of the brain involved among other considerations [9].…”