Treatment of intracerebral haemorrhage.
Apart from management in a specialised stroke or neurological intensive care unit, until very recently no specific therapies improved outcome after intracerebral haemorrhage (ICH). In a recent phase II trial, recombinant activated factor VII (eptacog alfa) reduced haematoma expansion, mortality, and disability when given within 4 h of ICH onset; a phase III trial (the FAST trial) is now in progress. Ventilatory support, blood-pressure reduction, intracranial-pressure monitoring, osmotherapy, fever control, seizure prophylaxis, and nutritional supplementation are the cornerstones of supportive care in intensive care units. Ventricular drainage should be considered in all stuporous or comatose patients with intraventricular haemorrhage and acute hydrocephalus. Given the lack of benefit seen in a the recent STICH trial, emergency surgical evacuation within 72 h of onset should be reserved for patients with large (>3 cm) cerebellar haemorrhages, or those with large lobar haemorrhages, substantial mass effect, and rapidly deteriorating condition.
Mayer
Stephan A
SA
Neurological Intensive Care Unit, Division of Stroke and Critical Care, Department of Neurology Columbia University, New York, NY 10032, USA. sam14@columbia.edu
Rincon
Fred
F
D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D002536:Cerebral Arteries / Q000473:pathology / Q000503:physiopathology*; D002543:Cerebral Hemorrhage / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy*; D003422:Critical Care / Q000379:methods; D019299:Decompression, Surgical; D015942:Factor VIIa / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D019586:Intracranial Hypertension / Q000150:complications / Q000503:physiopathology / Q000517:prevention & control; D011859:Radiography; D011993:Recombinant Fusion Proteins / Q000494:pharmacology / Q000627:therapeutic use
D011993:Recombinant Fusion Proteins; D015942:Factor VIIa