Intracranial Hemorrhage Follow-up

Updated: Oct 13, 2017
  • Author: David S Liebeskind, MD, FAAN, FAHA, FANA; Chief Editor: Helmi L Lutsep, MD  more...
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Follow-up

Further Outpatient Care

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  • After hospital discharge, continued physical, occupational, and speech therapy may be required.

  • Administer medications to control hypertension and to prevent complications such as seizures, urinary tract infections, or venous thromboses.

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Further Inpatient Care

Initial management of intracerebral hemorrhage generally is conducted in the ICU. Subsequent care generally includes the following:

  • Serial neurologic examinations

  • Treatment of elevated intracranial pressure

  • Placement of ventricular catheter should hydrocephalus develop

  • Avoidance of hypotension or hypertension (MAP = 70-130 mm Hg)

  • Use of isotonic solutions, such as normal saline, to minimize cerebral edema

  • Treatment with 3 X isotonic saline should hyponatremia due to cerebral salt wasting occur

  • Avoidance of hyperthermia

  • Treatment or prophylaxis of seizures

  • Treatment of urinary tract infections

  • Prevention of venous thrombosis with intermittent compression stockings plus or minus low-dose subcutaneous unfractionated or low molecular weight heparin

  • Prophylaxis for gastric ulcers

  • Physical, occupational, and speech therapy

  • Psychological support with cautious use of sedatives, if necessary

  • Repeat CT scan in case of clinical deterioration

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Inpatient & Outpatient Medications

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  • Antihypertensives for modification of blood pressure

  • Mannitol or other osmotic diuretics for elevated intracranial pressure

  • Acetaminophen for fever and headache relief

  • Fosphenytoin or other anticonvulsants for posttraumatic seizures

  • Famotidine or other antacids for gastric ulcer prophylaxis

  • Anticholinergics for bladder complications

  • Baclofen, diazepam, or tizanidine for spasticity

  • Amitriptyline, carbamazepine, or gabapentin for neuropathic pain

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Transfer

Following prehospital and emergent stabilization, patients with intracerebral hemorrhage should be transferred to a medical facility with neurosurgical expertise.

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Deterrence/Prevention

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  • Early detection and aggressive treatment of hypertension

  • Cautious management of anticoagulation and other antithrombotic medications

  • Careful selection of subjects suitable for thrombolysis

  • Consideration of cerebral amyloid angiopathy as a significant risk factor for intracerebral hemorrhage [17, 18]

  • Public education campaigns emphasizing the dangers of heavy alcohol intake and sympathomimetic use

  • Public education regarding traumatic brain injury, including appropriate use of safety equipment, precautions, and measures that may reduce the incidence of head injury

  • Prevention and management of preterm labor that may reduce intraventricular hemorrhage due to germinal matrix hemorrhage

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Complications

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  • Neurological deficits or death

  • Seizures

  • Hydrocephalus

  • Spasticity

  • Urinary complications

  • Aspiration pneumonia

  • Neuropathic pain

  • Deep venous thrombosis

  • Pulmonary emboli

  • Cerebral herniation

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Prognosis

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  • Early reduction in the level of consciousness carries an ominous prognosis.

  • The size and location of intracerebral hemorrhage provide useful prognostic information.

    • Larger hematomas have a worse outcome.

    • Lobar hemorrhage has a better outcome than deep hemorrhage.

    • Significant volume of intraventricular blood is a poor prognostic indicator.

  • The presence of hydrocephalus is associated with a poor outcome.

  • Good outcome in medium to large intracerebral hemorrhage can be predicted on admission by neurologic severity, intracerebral hemorrhage location, and fibrinogen levels. [19]

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Patient Education

Educate patients regarding the following:

  • Treatment of hypertension

  • Warning signs and symptoms of stroke as well as preventive measures

  • Traumatic brain injury

  • Adverse effects of alcohol and sympathomimetic substances

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