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  • Print publication year: 2011
  • Online publication date: December 2011

23 - Intracerebral haemorrhage

from Section 4 - Neurointensive care


Space-occupying lesions such as tumours, intracranial haematomas and abscesses are the most common indications for supratentorial surgery. Anaesthesia management is directed towards haemodynamic stability, facilitation of electrophysiological monitoring, and provision of optimal operative conditions and a rapid, high-quality recovery. The aim of pre-operative assessment is to identify potential anaesthetic problems and coexisting medical conditions, quantify risk and plan perioperative care. The assessment of the neurosurgical patient is identical to that of other patient groups but must additionally include a complete neurological assessment. Neuroanaesthesia is a specialty where the knowledge and skill of the anaesthetist affects both the operative field and ultimate outcome for the patient. Awake craniotomy allows the intraoperative assessment of a patient's neurological status and the identification of safe resection margins during epilepsy surgery and excision of space-occupying lesions in eloquent cortex, as well as the accurate localization of electrodes for deep brain stimulation.

Further reading

Adams, R. E. and Diringer, M. N. (1998). Response to external ventricular drainage in spontaneous intracerebral hemorrhage with hydrocephalus. Neurology 50, 519–23.
Auer, L. M., Deinsberger, W., Niederkorn, K. et al. (1989). Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study. J Neurosurg 70, 530–5.
Bhattathiri, P. S., Gregson, B., Prasad, K. S., Mendelow, A. D. and STICH Investigators (2006). Intraventricular hemorrhage and hydrocephalus after spontaneous intracerebral hemorrhage: results from the STICH trial. Acta Neurochir Suppl 96, 65–8.
Broderick, J., Connolly, S., Feldmann, E., et al. (2007). Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke 38, 2001–23.
Brott, T., Broderick, J., Kothari, R. et al. (1997). Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke 28, 1–5.
Claassen, J. (2007). Predictors and Significance of Electrographic Seizures and Periodic Disharges after Intracerebral Hemorrhage. New York: Columbia University Medical Center.
Coplin, W. M. Vinas, F. C., Agris, J. M. et al. (1998). A cohort study of the safety and feasibility of intraventricular urokinase for nonaneurysmal spontaneous intraventricular hemorrhage. Stroke 29, 1573–9.
Fernandes, H. M., Siddique, S., Banister, K. et al. (2000b). Continuous monitoring of ICP and CPP following ICH and its relationship to clinical, radiological and surgical parameters. Acta Neurochir Suppl 76, 463–6.
Freeman, W. D., Brott, T. G., Barrett, K. M. et al. (2004). Recombinant factor VIIa for rapid reversal of warfarin anticoagulation in acute intracranial hemorrhage. Mayo Clin Proc 79, 1495–500.
Gebel, J. M. Jr, Jauch, E. C., Brott, T. G. et al. (2002). Relative edema volume is a predictor of outcome in patients with hyperacute spontaneous intracerebral hemorrhage. Stroke 33, 2636–41.
Hemphill, J. C. III, Bonovich, D. C., Besmertis, L., Manley, G. T., Johnston, S. C. (2001). The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke 32, 891–7.
Juvela, S., Heiskanen, O., Poranen, A. et al. (1989). The treatment of spontaneous intracerebral hemorrhage. A prospective randomized trial of surgical and conservative treatment. J Neurosurg 70, 755–8.
Kothari, R. U., Brott, T., Broderick, J. P. et al. (1996). The ABCs of measuring intracerebral hemorrhage volumes. Stroke 27, 1304–5.
Liliang, P. C., Liang, C. L., Lu, C. H. et al. (2001). Hypertensive caudate hemorrhage prognostic predictor, outcome, and role of external ventricular drainage. Stroke 32, 1195–200.
Mayer, S. A. and Chong, J. (2002) Critical care management of increased intracranial pressure. J Int Care Med 17, 55–67.
Mayer, S. A. and Rincon, F. (2005). Treatment of intracerebral hemorrhage. Lancet Neurol 4, 662–72.
Mayer, S. A., Lignelli, A., Fink, M. E. et al. (1998). Perilesional blood flow and edema formation in acute intracerebral hemorrhage: a SPECT study. Stroke 29, 1791–8.
Mayer, S., Commichau, C., Scarmeas, N. et al. (2001). Clinical trial of an air-circulating cooling blanket for fever control in critically ill neurologic patients. Neurology 56, 292–8.
Mayer, S. A., Kowalski, R. G., Presciutti, M. et al. (2004). Clinical trial of a novel surface cooling system for fever control in neurocritical care patients. Crit Care Med 32, 2508–15.
Mayer, S. A., Brun, N. C., Begtrup, K. et al. (2005). Recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med 352, 777–85.
Mayer, S. A., Brun, N. C., Begtrup, K. et al. (2008). Efficacy and safety of recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med 358, 2127–37.
Mendelow, A. D., Gregson, B. A., Fernandes, H. M. et al. (2005). Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet 365, 387–97.
Misra, U. K., Kalita, J., Ranjan, P. and Mandal, S. K. (2005). Mannitol in intracerebral hemorrhage: a randomized controlled study. J Neurol Sci 234, 41–5.
Murthy, J. M., Chowdary, G. V., Murthy, T. V., Bhasha, P. S. and Naryanan, T. J. (2005). Decompressive craniectomy with clot evacuation in large hemispheric hypertensive intracerebral hemorrhage. Neurocrit Care 2, 258–62.
Naff, N. J., Carhuapoma, J. R., Williams, M. A. et al. (2000). Treatment of intraventricular hemorrhage with urokinase: effects on 30-day survival. Stroke 31, 841–7.
Nyquist, P. and Hanley, D. F. (2007). The use of intraventricular thrombolytics in intraventricular hemorrhage. J Neurol Sci 261, 84–8.
Ott, K. H., Kase, C. S., Ojemann, R. G. and Mohr, J. P. (1974). Cerebellar hemorrhage: diagnosis and treatment. A review of 56 cases. Arch Neurol 31, 160–7.
Passero, S., Rocchi, R., Rossi, S., Ulivelli, M. and Vatti, G. (2002). Seizures after spontaneous supratentorial intracerebral hemorrhage. Epilepsia 43, 1175–80.
Poungvarin, N., Bhoopat, W., Viriyavejakul, A. et al. (1987). Effects of dexamethasone in primary supratentorial intracerebral hemorrhage. N Engl J Med 316, 1229–33.
Qureshi, A. I. and Suarez, J. I. (2000). Use of hypertonic saline solutions in treatment of cerebral edema and intracranial hypertension. Crit Care Med 28, 3301–13.
Qureshi, A. I., Geocadin, R. G., Suarez, J. I. and Ulatowski, J. A. (2000). Long-term outcome after medical reversal of transtentorial herniation in patients with supratentorial mass lesions. Crit Care Med 28, 1556–64.
Rohde, V., Rohde, I., Thiex, R. et al. (2002). Fibrinolysis therapy achieved with tissue plasminogen activator and aspiration of the liquefied clot after experimental intracerebral hemorrhage: rapid reduction in hematoma volume but intensification of delayed edema formation. J Neurosurg 97, 954–62.
Rosand, J., Eskey, C., Chang, Y. et al. (2002). Dynamic single-section CT demonstrates reduced cerebral blood flow in acute intracerebral hemorrhage. Cerebrovasc Dis 14, 214–20.
Siddique, M. S., Fernandes, H. M., Wooldridge, T. D. et al. (2002). Reversible ischemia around intracerebral hemorrhage: a single-photon emission computerized tomography study. J Neurosurg 96, 736–41.
Teernstra, O. P., Evers, S. M., Lodder, J. et al. (2003). Stereotactic treatment of intracerebral hematoma by means of a plasminogen activator: a multicenter randomized controlled trial (SICHPA). Stroke 34, 968–74.
Tuhrim, S., Horowitz, D. R., Sacher, M. and Godbold, J. H. (1999). Volume of ventricular blood is an important determinant of outcome in supratentorial intracerebral hemorrhage. Crit Care Med 27, 617–21.
Zazulia, A. R., Diringer, M. N., Videen, T.O. et al. (2001). Hypoperfusion without ischemia surrounding acute intracerebral hemorrhage. J Cereb Blood Flow Metab 21, 804–10.