Stroke FM

08 Blood in the Brain is Bad (BBB)

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Key Terms: ICH, blood pressure control, spot sign

Hosts: Phavalan Rajendram, Neha Patel, Houman Khosravani

Summary:

  • Hemorrhagic strokes (HS) account for ~15-20% of all strokes
  • There is a significant morbidity and mortality associated with HS
  • Early blood pressure control is key in the management of HS
  • CTA can identify a spot sign (may indicate increased risk of hematoma expansion)
  • Etiologies
  • Find out if the patient is on anticoagulation so that it can be reversed
  • Make sure the patient is stable before CT scan (may need anti-emetics, intubation, etc.)
  • Early blood pressure control is key
  • Blood pressure target < 140/90
    • See ATACH-2 and INTERACT trials on BP control in ICH
    • Consult NSx early as surgical options may be available
      • See STICH-2 trial on surgical management of superficial ICH without IVH
      • Prognostication can be aided with “ICH Score”
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