New Treatment Strategies in the Management of Large Hemispheric Strokes and Intracerebral Hemorrhages

Edward M. Manno*

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Large ischemic strokes and intracerebral hemorrhage continue to have significant morbidity and mortality. Changes in our understanding of the cerebral hemodynamics of pressure volume shifts after expanding hemispheric mass lesions led to the development of hemicraniectomy to allow for expansion of edematous cerebral tissue outside of the skull. This technique has had considerable impact on morbidity and mortality. Patient identification and timing of surgery remain under investigation. Recent studies have revealed that ICH is a dynamic event with hematoma expansion occurring over the first few hours. Strategies to prevent or limit this expansion have focused on decreasing post-hemorrhage hypertension and inducing thrombosis. Similarly, secondary injury after hemorrhage may account for a noted increased neurological deficit compared to anatomic cellular loss. Medical strategies to prevent secondary neurological damage currently being studied include the use of iron chelators. The failure of surgical trials to reveal any benefit post-ICH has renewed interest in minimally invasive strategies to initiate clot removal. This combined with thrombolytics is currently being investigated with both intracerebral and intraventricular hemorrhage. The changing demographics of intracerebral hemorrhage with an increased incidence of hemorrhages secondary to anticoagulation may also shape future studies.

Original languageEnglish (US)
Title of host publicationEmergency Management in Neurocritical Care
PublisherWiley Blackwell
Pages92-98
Number of pages7
ISBN (Print)9780470654736
DOIs
StatePublished - Apr 11 2012

Keywords

  • Hemicraniectomy, in malignant cerebral edema, infarction
  • ICH dynamics, of several hours
  • IVH, primary or secondary to parenchymal ICH, worse outcome
  • Large hemispheric strokes of MCA territory
  • Large hemispheric strokes, and new treatment strategies
  • Mannitol effects on damaged brain tissue
  • Monroe-Kellie doctrine
  • Recombinant tPA, given early to patients with IVH
  • Treatment for ICH, limiting hematoma expansion

ASJC Scopus subject areas

  • Neuroscience(all)

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