Download - Intracerebral hemorrhage
Oct. 7, 2014
Emergent Extraventricular drainage
L’t deep white matter hemorrhage extended to ventricle
Oct.7, 2014
GCS: E2VTM5 SBP around 120-150
Oct.9, 2014
Drowsy consciousnessMal-function of the EVD, 3ml in recent 3 daysGCS: E2VTM4 SBP around 130-150=> Malfunction of the EVD, ==> Arranged brain CT to check position
Oct.7, 2014
GCS: E2VTM5 SBP around 120-150
Oct.9, 2014
Drowsy consciousnessMal-function of the EVD, 3ml in recent 3 daysGCS: E2VTM4 SBP around 130-150=> Malfunction of the EVD, ==> Arranged brain CT to check position
Oct.12, 2014
Removed endotracheal tube E3V3M6SBP: 140-160
Oct.14, 2014
Drowsy consciousnessGCS: E3V1M5 SBP around 120-160
Oct.15, 2014
Post-OPGCS: E3VtM5 SBP around 130-170
Oct.14, 2014
Drowsy consciousnessGCS: E3V1M5 SBP around 120-160
Oct.16, 2014
GCS: E2VtM4 SBP: 120-160 Mal-function of the EVD
Oct.15, 2014
Post-OPGCS: E3VtM5 SBP around 130-170
Oct.20, 2014
Removed endotracheal tube E4V2M5SBP: 120-160
Oct.30, 2014
Arranged Ventriculoperitoneal shunt
Final diagnosisL’t deep white matter intracerebral hemorrhage with L’t intraventricular hemorrhage s/p EVD, followed by right frontal ICH and right IVH s/p stereostatic aspiration and EVD s/p VP shunt
Question
1. Management of intracerebral hemorrhage
2. The relationship between location of the intracerebral hemorrhage and intraventricular hemorrhage
Crit Care Clin 30 (2014) 699–717
blood pressure
reduction
cerebral edema
management
surgical interven-
tions
coagulo-pathy
reversal
Timing of SurgeryCerebellar hemorrhage
Brainstem compression
Hydrocephalus from ventricular obstruction
Intraventricular hemorrhage
For patients presenting with lobar clots >30 mL
For most patients with ICH, the usefulness of surgery is uncertain
Stroke. 2010;41:2108-2129
surgical interven-
tions
Coagulopathy reversalINR greater than 1.4 caused by warfarin
1. Fresh- frozen plasma (FFP)
2. Vitamin K
3. Prothrombin complex concentrates
4. Recombinant activated factor 7 (rFVIIa)
coagulo-pathy
reversal
Crit Care Clin 30 (2014) 699–717
Crit Care Clin 30 (2014) 699–717
blood pressure
reduction
cerebral edema
management
surgical interven-
tions
coagulo-pathy
reversal
Crit Care Med 2013; 41:1325–1331
Study deisionNationwide, prospective cohort (N= 1,604)
Method:Analyzed CT scan images taken within 48 hours after stroke onset
ConclusionHigh relationship with white matter lesion, deep structure and cerebellum
No relationship with sex, age, HTN, DM.
Crit Care Med 2013; 41:1325–1331
Lancet 2013; 382: 397–408
1. Surgical hematoma treatment2. Reduction of hypertension3. Reversal of coagulopathies or anticoagulants4. Hemostatic therapy
Stroke. 2010;41:402-409
Back to our patientblood
pressure reduction
cerebral edema
management
surgical interven-
tions
coagulo-pathy
reversal
Back to our patient
Relative high risk of IVH by the location
Surgical intervention is essential to our patient due to possibly obstructive hydrocephalus due to IVH
Intensive blood pressure control ( target SBP < 140) should be considered