5. Treatment of Hemorrhagic Stroke

  1. Kevin M. Barrett MD, MSc2 and
  2. James F. Meschia MD3
  1. Andreas H. Kramer MD, MSc, FRCPC

Published Online: 7 MAY 2013

DOI: 10.1002/9781118560730.ch5

Stroke

Stroke

How to Cite

Kramer, A. H. (2013) Treatment of Hemorrhagic Stroke, in Stroke (eds K. M. Barrett and J. F. Meschia), John Wiley & Sons, Oxford. doi: 10.1002/9781118560730.ch5

Editor Information

  1. 2

    Mayo Clinic, Jacksonville, FL, USA

  2. 3

    Mayo Clinic, Jacksonville, FL, USA

Author Information

  1. Departments of Critical Care Medicine and Clinical Neurosciences, Hotchkiss Brain Institute, Foothills Medical Center, University of Calgary, Alberta, Canada

Publication History

  1. Published Online: 7 MAY 2013
  2. Published Print: 22 APR 2013

ISBN Information

Print ISBN: 9780470674369

Online ISBN: 9781118560730

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Keywords:

  • intracerebral hemorrhage;
  • subarachnoid hemorrhage;
  • hydrocephalus;
  • aneurysm;
  • vasospasm

Summary

Intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) account for about 10–20% of strokes. Compared with ischemic stroke, neurological impairment tends to be more severe and outcomes are generally worse. An improved understanding of the pathophysiology of these conditions has increased the therapeutic options. With ICH, efforts focus on reducing early hematoma expansion and attenuating perihematomal edema. With SAH, clinicians must seek to prevent aneurysm rebleeding and limit both early and delayed ischemic injury. Prevention and timely recognition and treatment of potential causes of secondary brain injury, such as hydrocephalus, nonconvulsive seizures, intracranial hypertension, fever, anemia, hypoxemia, hypotension and hypo- or hyperglycemia, is crucial in maximizing the chance of a favorable recovery. Systemic complications, such as neurogenic stunned myocardium and pulmonary edema, must be recognized and treated appropriately. For patients with stupor and coma, physicians should communicate regularly with surrogate decision makers. Assessment of patients' prognosis should be transparent, based on best available evidence, and neither unrealistically optimistic nor pessimistic.