HEMISPHERES VI - HEMORRHAGIC STROKE -
INPATIENT QUESTIONS WITH VERIFIED ANSWERS
Intracerebral Hemorrhage (ICH)
10%
Occurs when an intracerebral blood vessel bursts leaking blood inside
the brain tissue
Subarachnoid Hemorrhage (SAH)
3%
Occurs when a blood vessel in the subarachnoid space ruptures causing
blood to leak into this space and cerbrospinal fluid surrounding the
brain
General focus of ICH managment
Anticoagulation/coagulopathy reversal - as warranted
Blood pressure control - acute lowering to target SBP 140
Seizure control - treat clinical seizures only
Complication management - expansion of hematoma, elevated ICP
hydrocephalus, herniation
Subarachnoid Hemorrhage (SAH) general focus
Anticoagulation reversal
BP control - target SBP <160 to prevent rebleeding
Aneurysm repair - endovascular coiling or surgical clipping
, Seizure control - prophylaxis may be considered when high risk
characteristics are present
Complication management - rebleeding, cerebral vasospasm, delayed
cerebral ischemia, hydrocephalus, and elevated intracranial pressure
High risk characteristics for seizure prophylaxis
Ruptured MCA aneurysm, high-grade aSAH, ICH, hydrocephalus or
cortical infarction
Potential ICH/SAH presentation on arrival
Cardiopulmonary instability or post arrest
Cerebral ischemia -from vasospasm
Active seizures
Active hemorrhage - post reperfusion
Active herniation
Hypo/hyperglycemia
Electrolyte imbalance-hyponatremia
Hyperthermia
When is reversal of anticoagulants required
ICH stroke patients with INR >1.4
When to consider activated charcoal for anticoagulant reversal
if most recent oral anticoagulant dose was < 2 hrs
Warfarin Reversal
4 factor prothrombin complex concentrate (PCC) and IV vit K
Fresh frozen plasma if 4 factor PCC unavailable
Direct Thrombin Inhibitor reversal Dabigatran
INPATIENT QUESTIONS WITH VERIFIED ANSWERS
Intracerebral Hemorrhage (ICH)
10%
Occurs when an intracerebral blood vessel bursts leaking blood inside
the brain tissue
Subarachnoid Hemorrhage (SAH)
3%
Occurs when a blood vessel in the subarachnoid space ruptures causing
blood to leak into this space and cerbrospinal fluid surrounding the
brain
General focus of ICH managment
Anticoagulation/coagulopathy reversal - as warranted
Blood pressure control - acute lowering to target SBP 140
Seizure control - treat clinical seizures only
Complication management - expansion of hematoma, elevated ICP
hydrocephalus, herniation
Subarachnoid Hemorrhage (SAH) general focus
Anticoagulation reversal
BP control - target SBP <160 to prevent rebleeding
Aneurysm repair - endovascular coiling or surgical clipping
, Seizure control - prophylaxis may be considered when high risk
characteristics are present
Complication management - rebleeding, cerebral vasospasm, delayed
cerebral ischemia, hydrocephalus, and elevated intracranial pressure
High risk characteristics for seizure prophylaxis
Ruptured MCA aneurysm, high-grade aSAH, ICH, hydrocephalus or
cortical infarction
Potential ICH/SAH presentation on arrival
Cardiopulmonary instability or post arrest
Cerebral ischemia -from vasospasm
Active seizures
Active hemorrhage - post reperfusion
Active herniation
Hypo/hyperglycemia
Electrolyte imbalance-hyponatremia
Hyperthermia
When is reversal of anticoagulants required
ICH stroke patients with INR >1.4
When to consider activated charcoal for anticoagulant reversal
if most recent oral anticoagulant dose was < 2 hrs
Warfarin Reversal
4 factor prothrombin complex concentrate (PCC) and IV vit K
Fresh frozen plasma if 4 factor PCC unavailable
Direct Thrombin Inhibitor reversal Dabigatran
