Neurocritical Care Guide
This guide is intended to provide general information about disease processes treated in the Neurocritical care unit at Stanford University Medical Center. Information about clinical trials and research are under the Clinical Trials section.
Intracerebral hemorrhage
- Non-traumatic intracerebral hemorrhage (ICH) is a bleed that occurs in the brain tissue and accounts for ~ 10% of all strokes
- ICH can present with symptoms of: sudden severe headache, acute onset of loss of consciousness, and focal neurological deficits, such as weakness, numbness, speech changes and visual changes.
- Most spontaneous ICHs are due to underlying hypertension.
- In the elderly it may be due to protein deposition into the blood vessels that make them bleed more easily [cerebral amyloid angiopathy (CAA)].
- Other patients have bleeding secondary to a tangle of blood vessels called arteriovenous malformation or other vascular abnormality.
- The diagnosis is made on a noncontrast brain CT scan or Magnetic Resonance Imaging (MRI).
- The management principles are described below:
- Patients with severe neurological injury may require airway protection with an endotracheal tube and ventilator support.
- Medications are given for blood pressure control.
- Patients on warfarin (Coumadin) will require medications (vitamin K and prothrombin complex concentrate) and blood products (fresh frozen plasma) to reverse the blood thinning effects.
- Some patients will require placement of a ventricular drainage catheter into the fluid filled cavities of the brain, the ventricules, to relieve pressure inside the skull and drain out bloody fluid when present.
- Surgery may be required to remove the blood clot depending on the location and size of the blood clot.
- Swelling of the brain usually peaks 2- 5 days after the ICH but may last for weeks. Patients may need intravenous salty solutions (3% and 23% NaCl) and/or other medications (mannitol) to help alleviate the swelling around the clot.
- Higher mortality and worse functional outcomes are expected among patients who have the following characteristics: elderly (= 80), larger blood clots (= 30 cm3), blood in the ventricles, location in lower brain (brainstem and cerebellum), and worse neurological function at time of presentation to hospital.
- Some patients have a poor recovery and will require tracheostomy for airway protection and feeding tube into the stomach (gastric tube) for supportive care.
