Stroke Research & Therapy

Description

Intracerebral Haemorrhage (ICH) is a life-threatening condition with a high rate of morbidity and fatality. The fourth in a series on stroke from Missouri medicine outlines the clinical and imaging components of ICH diagnosis. Current medicinal and surgical treatments are described, as well as outcome predictors and secondary prevention measures.

Epidural hematoma, subdural hematoma, Subarachnoid Haemorrhage (SAH), Intraventricular Haemorrhage (IVH), Hemorrhagic Transformation of ischemic stroke (HT), venous haemorrhage from cortical vein or sinus thrombosis, and intracerebral haemorrhage are all examples of intracranial haemorrhage. The primary topic of this, the fourth in a six-part Missouri Medicine Stroke series, is Intracerebral Haemorrhage (ICH), which includes Intraventricular Haemorrhage for the sake of this discussion (IVH). Subarachnoid Haemorrhage is more discussed in (SAH).

Intracerebral haemorrhage is responsible for 10%-15% of all strokes and is associated with extremely high morbidity and fatality rates that have remained constant over the previous 30 years. Death rates range from 51% to 65% after a year, depending on the site of the haemorrhage. The first two days account for half of all deaths. Only 20% of patients are predicted to be self-sufficient after six months. Hemorrhage is more common in men than in women and increases exponentially with age.

The main presenting hallmark of ICH is a sudden onset of localized neurological impairment that worsens over minutes to hours. The location of the initial bleeding and subsequent edoema is reflected in the nature of the impairments. Seizures, vomiting, headaches, and a loss of consciousness are all frequent side effects. In acute ischemic strokes, both headache and a reduced degree of consciousness are uncommon.

In ICH, the risk of neurological degeneration and cardiac instability is significant from the outset, necessitating prompt diagnosis and treatment. It's crucial to know if there a history trauma,hypertension, excessive alcohol use, or any prescription or recreational drug use, such as cocaine, warfarin, aspirin, or clopidogrel, or if there's a hematologic condition.

The primary goal of the physical examination is to check vital signs and establish whether sedation is necessary for imaging safety. It's crucial to figure out if patients with extremely high blood pressure are at risk for acute myocardial infarction. After the patient has been medically stabilized, get stat labs such as protime/INR, PTT, CBC with platelet count, D-dimer, fibrinogen, electrolytes, BUN/creatinine, glucose, liver functions and type, screen to blood bank, and get the patient to an imaging study as quickly as feasible.

The neuro-rehabilitation team must be mobilized and involved as soon as possible in order to maximize recovery. Severe ICH patients may do better than those who have suffered a severe ischemic stroke.

Per patient year, there is a 2.1%-3% chance of recurrent ICH. Recurrence is more common in lobar hemorrhages, which is likely due to underlying amyloid angiopathy. Older age, anticoagulation, and the APOE genotype, which is linked to amyloid deposition, are all factors that increase the chance of recurrence. Smoking, heavy alcohol use, and cocaine use are all linked to an increased risk of ICH, hence cessation programs should be implemented.

Conclusion

Anticoagulation is a problematic issue in people who have had an ICH and also have atrial fibrillation or another illness for which warfarin is prescribed. When the previous haemorrhage was lobar rather than subcortical, anticoagulated patients have a greater risk of recurrent ICH. In general, using warfarin in patients who have had an ICH is considered to be a significant contraindication. Antiplatelet therapy is controversial due to a lack of proof. This is a situation that should be handled on a case-by-case basis. These are assessments of diagnosis which can be control ICH to some extent.