Intracranial Hemorrhage and Intracranial Hypertension - 28/06/19

Doi : 10.1016/j.emc.2019.04.001

Evie Marcolini, MD ^a,^b,^⁎ , Christoph Stretz, MD ^c, Kyle M. DeWitt, PharmD ^d
^a Department of Surgery, Division of Emergency Medicine, University of Vermont College of Medicine, 111 Colchester Avenue, Burlington, VT 05401, USA
^b Department of Neurology, Division of Neurocritical Care, University of Vermont College of Medicine, 111 Colchester Avenue, Burlington, VT 05401, USA
^c Division of Vascular Neurology, Yale School of Medicine, 15 York Street, LLCI Building Suite 1004, New Haven, CT 06510, USA
^d Department of Pharmacy, The University of Vermont Medical Center, 111 Colchester Avenue, Mailstop 272 BA1, Burlington, VT 05401, USA

^∗Corresponding author. 111 Colchester Avenue, Burlington, VT 05401, USA.111 Colchester AvenueBurlingtonVT05401USA

Résumé

Central nervous system hemorrhage has multiple pathophysiologic etiologies, including intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and traumatic brain injury (TBI). Given the nuances intrinsic to each of these etiologies and pathophysiologic processes, optimal blood pressure varies significantly and depends on type of hemorrhage and individual characteristics. This article reviews the most current evidence regarding blood pressure targets and provides guidance on reversal of anticoagulation for TBI, ICH, and SAH. It also describes the assessment, optimal therapeutic targets, and interventions to treat intracranial hypertension that can result from TBI, ICH, or SAH.

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Keywords : Intracerebral hemorrhage, Subarachnoid hemorrhage, Traumatic brain injury, Blood pressure, Anticoagulation, Intracranial hypertension, Herniation, ICP monitoring