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Intracerebral Hemorrhage, Emergency Medicine

Atul Gupta and Rebecca Smith- Coggins Reviewed 06/2017
 


Basics

Description

Hemorrhage into brain parenchyma: 
  • Compression of brain tissues

  • Secondary injury results from:

    • Cerebral edema

    • Increased intracranial pressure (ICP)

    • Potential of brain herniation

Etiology

In...

Diagnosis

Signs and Symptoms

History

  • Severe headache, typically sudden in onset

  • Seizure

  • Evidence of head injury

  • Neck stiffness

  • Vomiting

  • Anticoagulation therapy

  • Altered level of consciousness (may be comatose)...

Treatment

Pre-Hospital

  • C-spine precautions if head or neck injury is suspected

  • Elevation of head with C-spine control

  • Initial pre-hospital responder must ascertain neurologic defect to be able to note pr...

Follow-Up

Disposition

Admission Criteria

  • To OR if surgical intervention is indicated

  • To ICU if intubated, altered level of consciousness, or on IV infusion for BP control

  • Admit to neurologic observation u...

Pearls and Pitfalls

  • Brain imagining is a crucial part of emergent evaluation of patients with headache, HTN, and/or altered level of consciousness

  • Cautious BP control because acute lowering of BP to no...

Additional Reading

  • Broderick  J, Connolly  S, Feldmann  E, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: A guideline from the American Heart Asso...

Codes

ICD9

  • 431 Intracerebral hemorrhage

  • 853.00 Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness

ICD10

  • I61.9 Non...

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