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Ebook Neurointensive care: Part 2

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Nội 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 one

Ebook 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 mic

Chapter 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 in

clude amyloid angiopathy, trauma, infections, intracranial neoplasm. coagulopathy (either inherent or drug induced, such as chronic vitamin K antagoni Ebook Neurointensive care: Part 2

st therapy and thrombolytic therapy), cerebral venous thrombosis, and abnormalities of blood vessels (such as arteriovenous malformations, cavernous a

Ebook 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 assoc

Chapter 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 2

nset of nausea, vomiting, speech disturbance, and right hemiparesis. He was on amlodipine 5 mg and irbesartan 150 mg every morning for hypertension. T

Ebook 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 responsiv

Chapter 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 intraventricula

r 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 2

dministration of 1 mg tissue plasminogen activator (tPA) every 8 h via external ventricular drainage (EVD) was applied to reduce IVH volume and ICP.Ri

Ebook 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. Morbidi

Chapter 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 expansi

on 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 2

se damage to the brain cells surrounding the hemorrhage. If the amount of blood increases rapidly, the sudden buildup in ICP can lead to unconsciousne

Ebook 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 strong

Chapter 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 prevent

ion and management of elevated intracranial pressure along with other neurologic and medical complications. The patients should be monitored and treat Ebook Neurointensive care: Part 2

ed in an NICU.Blood PressureIn general, the American Heart Association guidelines indicate that systolic BP exceeding 180 mmHg or mean arterial pressu

Ebook 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 of

Chapter 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 ische

mic 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 2

bral edema and intracranial pressure, and sublingual agents are not preferred because of148M.K. HanTable 9.1 Intravenous anti-hypertensive agents for

Ebook 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; 0

Chapter 9Intracerebral HemorrhageMoon Ku HanIntroductionSpontaneous or nontraumatic intracerebral hemorrhage (ICH) is associated with poor outcome, a

Ebook Neurointensive care: Part 2ongestive heart failure, bronchospasm

Chapter 9Intracerebral HemorrhageMoon Ku HanIntroductionSpontaneous or nontraumatic intracerebral hemorrhage (ICH) is associated with poor outcome, a

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