Intracerebral Bleeds (ICH)

The Problem:
These are usually hypertensive but can also come from arteriovenous malformations (AVMs), tumours or from aneurysms. The location of the bleed will determine the management eg. if the bleed is very large and in a non-dominant lobe, this can make an operative intervention earlier. Further investigation (angiogram) into the origin of the bleed really depends on the location of the blood (i.e. old with a hypertensive bleed in the basal ganglia vs young with a cortical AVM bleed).

What We Do:
Again, check the INR/PTT, CBC and fix what you can. Load the patient with Dilantin (1 gram IV). Keep the patient NPO for the first night. Set some parameters for blood pressure. All of these patients tend to get worse on the second and third day. Watch out for edema and re-CT if they get worse.

Links:

Evidence Footnotes:
Authorship: Dr John Wells Last Revised: 3 June 2002
 
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