Intracerebral and Subarachnoid Hemorrhage; Decision Points in Neurovascular Critical Care
Jae Hoon Sung, MD, PhD Jae Hoon Sung, MD, PhD
Department of Neurosurgery, St. Vincent’s Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
ABSTRACT
The spontaneous intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) are main disease entities which need early aggressive intensive care. In cases of ICH, the untreated or mal-treated hypertension is outstanding cause and strict control is mandatory for prevention of rebleeding or subsequent brain edema. Modern evidence based recommendations stress conservative management, rather than aggressive operative removal, but in some cases of ICH, other causes should be ruled out or treated with operative treatment. We briefly comment these basic principles and considering points for ICH treatment. The spontaneous SAH cases, most of them are elicited by ruptured cerebral aneurysms, need more sophisticated treatment. Early operative clipping or endovascular coiling is standard treatment modality to prevent rebleeding, but it should be followed by aggressive neurovascular intensive care focusing cerebral blood flow and brain edema to overcome other unique, horrible complications of SAH. In this review, we discuss about main pathophysiology of aneurysmal SAH and some complications briefly.
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