tailieunhanh - Báo cáo y học: "Clinical review: Critical care management of spontaneous intracerebral hemorrhage"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Clinical review: Critical care management of spontaneous intracerebral hemorrhage. | Available online http content 12 6 237 Review Clinical review Critical care management of spontaneous intracerebral hemorrhage Fred Rincon1 and Stephan A Mayer2 1 Department of Medicine Cooper University Hospital The Robert Wood Johnson Medical School University of Medicine and Dentistry of New Jersey Camden NJ 08501 USA 2Neurological Intensive Care Unit Division of Stroke and Critical Care Department of Neurology and the Department of Neurosurgery College of Physicians and Surgeons SAM Columbia University New York NY 10032 USA Corresponding author Stephan A Mayer sam14@ Published 10 December 2008 Critical Care 2008 12 237 doi cc7092 This article is online at http content 12 6 237 2008 BioMed Central Ltd Abstract Intracerebral hemorrhage is by far the most destructive form of stroke. The clinical presentation is characterized by a rapidly deteriorating neurological exam coupled with signs and symptoms of elevated intracranial pressure. The diagnosis is easily established by the use of computed tomography or magnetic resonance imaging. Ventilatory support blood pressure control reversal of any preexisting coagulopathy intracranial pressure monitoring osmotherapy fever control seizure prophylaxis treatment of hyerglycemia and nutritional supplementation are the cornerstones of supportive care in the intensive care unit. Dexamethasone and other glucocorticoids should be avoided. Ventricular drainage should be performed urgently in all stuporous or comatose patients with intraventricular blood and acute hydrocephalus. Emergent surgical evacuation or hemicraniectomy should be considered for patients with large 3 cm cerebellar hemorrhages and in those with large lobar hemorrhages significant mass effect and a deteriorating neurological exam. Apart from management in a specialized stroke or neurological intensive care unit no specific medical therapies have been shown to consistently improve outcome after intracerebral .