Neurológia pre prax 2/2017

Intracerebral hemorrhage

Intraparenchymal hemorrhage (ICH) accounts for 10–20 % of all strokes, its mortality is much higher compared to ischemic strokes. 55 % of hematomas are localised deeply in brain hemisphere, 30 % in lobes and 15 % in the brain stem. The most frequent causes of ICH are hypertensive vasculopathy, amyloid angiopathy, vessel malformation or tumors. ICH patients should be admited to an ICU, the goal of therapy is blood pressure normalisation using intravenous drugs, coagulopathy treatment in patients on anticoagulation therapy and cerebral edema treatment. Prophylactic antiseizure medication is not recommended. Surgical treatment is effective in cerebellar or superficial hemorrhages. Anticoagulation after ICH is possible in carefully selected patients, an alternative approach in atrial fibrilation patients is left appendage closure.

Keywords: intraparenchymal hemorrhage, hypertension, edema, coagulopathy, anticoagulation