08 Blood in the Brain is Bad (BBB)

Key Terms: ICH, blood pressure control, spot sign

Hosts: Phavalan Rajendram, Neha Patel, Houman Khosravani

Summary:

• Hemorrhagic strokes (HS) account for ~15-20% of all strokes
  
• There is a significant morbidity and mortality associated with HS
  
• Early blood pressure control is key in the management of HS
  
• CTA can identify a spot sign (may indicate increased risk of hematoma expansion)
  
• Etiologies
  
• Find out if the patient is on anticoagulation so that it can be reversed
  
• Make sure the patient is stable before CT scan (may need anti-emetics, intubation, etc.)
  
• Early blood pressure control is key
  
• Blood pressure target < 140/90
  
  • See ATACH-2 and INTERACT trials on BP control in ICH
    
• Consult NSx early as surgical options may be available
  
  • See STICH-2 trial on surgical management of superficial ICH without IVH
    
• Prognostication can be aided with “ICH Score”