Neurology
Intracerebral Hemorrhage
Neurology

Intracerebral Hemorrhage

HTN with sudden focal deficit + vomiting → CT first, never lytics.

Select any text to highlight it or make a flashcard.

◆Approach

  • •Sudden focal deficit + vomiting + HTN → think ICH
  • •Always non-contrast CT BEFORE thrombolytics

◆Management

  • •Reverse anticoagulation per agent (warfarin → 4F-PCC + vit K; dabigatran → idarucizumab; FXa inhibitors → andexanet/4F-PCC; heparin → protamine)
  • •Target systolic 140 in spontaneous ICH
  • •ICP management: HOB 30°, mannitol/hypertonic saline, sedation
  • •Surgical evacuation if cerebellar bleed >3 cm or worsening
  • •Avoid prophylactic anticonvulsants unless seizure occurs

High-yield pearls

  • ◆Cushing reflex (HTN, bradycardia, irregular respirations) = ↑ICP
  • ◆Spot sign on CTA predicts hematoma expansion
Done reading?
Track your progress by marking this complete.
Next in Neurology