Ebook Neurointensive care: Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Neurointensive care: Part 2
Ebook Neurointensive care: Part 2
Chapter 9Intracerebral HemorrhageMoon Ku HanIntroductionSpontaneous or nontraumatic intracerebral hemorrhage (ICH) is associated with poor outcome, a Ebook Neurointensive care: Part 2 higher case fatality than ischemic stroke, and is one of the leading causes of death. Patients with ICH are among the highest number of admissions to the neurocritical intensive care unit (NICU) 11].ICH represents 10-15 % of all strokes, but the median I month case fatality is 40-50 % with only 38 Ebook Neurointensive care: Part 2% surviving the first year [2J. The Oxfordshire Community Stroke Project estimated that about 60 % of the patients with ICH do not survive beyond oneEbook Neurointensive care: Part 2
year [3]. Outcome is determined by the initial severity of the bleeding, and treatment regimens are limited [4].The most common etiology of ICH is micChapter 9Intracerebral HemorrhageMoon Ku HanIntroductionSpontaneous or nontraumatic intracerebral hemorrhage (ICH) is associated with poor outcome, a Ebook Neurointensive care: Part 2ften causes no symptoms, many people with ICH are not aware that they have high BP. or that their BP needs to be treated. Less common causes of ICH include amyloid angiopathy, trauma, infections, intracranial neoplasm. coagulopathy (either inherent or drug induced, such as chronic vitamin K antagoni Ebook Neurointensive care: Part 2st therapy and thrombolytic therapy), cerebral venous thrombosis, and abnormalities of blood vessels (such as arteriovenous malformations, cavernous aEbook Neurointensive care: Part 2
ngioma, venous angioma). Other risk factors for ICH appeared to be advanced age, male sex. and high alcohol intake. High cholesterol tends to be assocChapter 9Intracerebral HemorrhageMoon Ku HanIntroductionSpontaneous or nontraumatic intracerebral hemorrhage (ICH) is associated with poor outcome, a Ebook Neurointensive care: Part 2an@snu.ac.kr© Springer International Publishing Switzerland 2015K.E. Wartenberg et al. (eds.). Neu min tensive Care: .4 Clinical GuideMnni in 1007/070 1 no 17'101 4 o145M.K. Han146CaseA 63-year-old Korean man with a history of hypertension and alcohol abuse was admitted to the hospital with sudden o Ebook Neurointensive care: Part 2nset of nausea, vomiting, speech disturbance, and right hemiparesis. He was on amlodipine 5 mg and irbesartan 150 mg every morning for hypertension. TEbook Neurointensive care: Part 2
he lime of onset of symptoms was approximately 50 min ago. On arrival at the emergency department, the patient was found to be somnolent and responsivChapter 9Intracerebral HemorrhageMoon Ku HanIntroductionSpontaneous or nontraumatic intracerebral hemorrhage (ICH) is associated with poor outcome, a Ebook Neurointensive care: Part 2R): 26, blood sugar by lingerstick: 160 mg/dL (8.8 mmol/L). Initial computed tomography (CT) scan showed a left basal ganglia ICH with intraventricular hemorrhage (IVH) into the left lateral ventricle (Fig. 9.1). Early intensive BP lowering (systolic BP< 140 mmHg) was achieved and intraventricular a Ebook Neurointensive care: Part 2dministration of 1 mg tissue plasminogen activator (tPA) every 8 h via external ventricular drainage (EVD) was applied to reduce IVH volume and ICP.RiEbook Neurointensive care: Part 2
sks of Patient Safety and ManagementOutcomes with 1CH are significantly worse than with ischemic stroke, with up to 50 % mortality at 30 days. MorbidiChapter 9Intracerebral HemorrhageMoon Ku HanIntroductionSpontaneous or nontraumatic intracerebral hemorrhage (ICH) is associated with poor outcome, a Ebook Neurointensive care: Part 2entorial hematoma [6]. Almost 40 % of patients with brain imaging obtained in the first 3 h after onset of symptoms of ICH experience hematoma expansion and this is highly associated with the increase of ICP and neurological deterioration [7]. The sudden increase in pressure within the brain can cau Ebook Neurointensive care: Part 2se damage to the brain cells surrounding the hemorrhage. If the amount of blood increases rapidly, the sudden buildup in ICP can lead to unconsciousneEbook Neurointensive care: Part 2
ss or death. Expanding hematoma results from persistent and/or secondary bleeding at (he periphery of an existing clot. Recent studies showed a strongChapter 9Intracerebral HemorrhageMoon Ku HanIntroductionSpontaneous or nontraumatic intracerebral hemorrhage (ICH) is associated with poor outcome, a Ebook Neurointensive care: Part 2al goals of treatment include stabilization of airway, breathing, and circulation. followed by preventing hemorrhage extension, as well as the prevention and management of elevated intracranial pressure along with other neurologic and medical complications. The patients should be monitored and treat Ebook Neurointensive care: Part 2ed in an NICU.Blood PressureIn general, the American Heart Association guidelines indicate that systolic BP exceeding 180 mmHg or mean arterial pressuEbook Neurointensive care: Part 2
re (MAP) exceeding 130 mmHg should be managed with continuous-infusion antihypertensive agents (Table 9.1) [9]. There was concern about a reduction ofChapter 9Intracerebral HemorrhageMoon Ku HanIntroductionSpontaneous or nontraumatic intracerebral hemorrhage (ICH) is associated with poor outcome, a Ebook Neurointensive care: Part 2n into the left lateral ventriclehemorrhage with aggressive BP reduction. However, despite a peri-hematomal reduction of cerebral metabolism, an ischemic zone was not found on several radiographic cerebral metabolism studies.The use of nitroprusside has drawbacks since this agent may exacerbate cere Ebook Neurointensive care: Part 2bral edema and intracranial pressure, and sublingual agents are not preferred because of148M.K. HanTable 9.1 Intravenous anti-hypertensive agents forEbook Neurointensive care: Part 2
blood pressure reduction in 1CHDrugMechanismDoseContraindicationsI.ahetalola-l.p-l.p-2 receptor antagonist10-80 mg bolus every 10 min. up to 300 mg; 0Chapter 9Intracerebral HemorrhageMoon Ku HanIntroductionSpontaneous or nontraumatic intracerebral hemorrhage (ICH) is associated with poor outcome, a Ebook Neurointensive care: Part 2ongestive heart failure, bronchospasmChapter 9Intracerebral HemorrhageMoon Ku HanIntroductionSpontaneous or nontraumatic intracerebral hemorrhage (ICH) is associated with poor outcome, aGọi ngay
Chat zalo
Facebook