Current intracerebral haemorrhage management

被引:107
作者
Butcher, K
Laidlaw, J
机构
[1] Royal Melbourne Hosp, Dept Nephrol, Parkville, Vic 3050, Australia
[2] Royal Melbourne Hosp, Dept Neurosci Neurol & Neurosurg, Parkville, Vic 3050, Australia
关键词
risk factors; diagnosis; pathology; prognosis; prevention;
D O I
10.1016/S0967-5868(02)00324-7
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Primary intracerebral haemorrhage (ICH) refers to spontaneous bleeding from intraparenchymal vessels. It accounts for 10-20% of all strokes, with higher incidence rates amongst African and Asian populations. The major risk factors are hypertension and age. In addition to focal neurological findings, patients may present with symptoms of elevated intracranial pressure. The diagnosis of ICH can only be made through neuro-imaging. A CT scan is presently standard, although MRI is increasingly important in the evaluation of acute cerebrovascular disease. A significant proportion of intracerebral haematomas expand in the first hours post-ictus and this is often associated with clinical worsening. There is evidence that the peri-haematomal region is compromised in ICH. This tissue is oedematous, although the precise pathogenesis is controversial. An association between elevated arterial pressure and haematoma expansion has been reported. Although current guidelines recommend conservative management of arterial pressure in ICH, an acute blood pressure lowering trial is overdue. ICH is associated with a high early mortality rate, although a significant number of survivors make a functional recovery. Current medical management is primarily aimed at prevention of complications including pneumonia and peripheral venous thromboembolism. Elevated intracranial pressure may be treated medically or surgically. Although the latter definitively lowers elevated intracranial pressure, the optimal patient selection criteria are not clear. Aggressive treatment of hypertension is essential in the primary and secondary prevention of ICH. (C) 2003 Elsevier Science Ltd. All rights reserved.
引用
收藏
页码:158 / 167
页数:10
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