Management – Overview

The management of hemorrhagic stroke focuses on stabilizing the patient, minimizing further brain injury, and preventing complications. The overarching goals of treatment include controlling blood pressure, managing intracranial pressure, preventing rebleeding, and providing supportive care.

1. General Measures:
   ● Airway management: Ensure adequate oxygenation and ventilation.
   ● Hemodynamic stability: Maintain stable blood pressure and heart rate within target ranges.
   ● Intracranial pressure management: Monitor and control intracranial pressure to prevent further brain injury.
   ● Seizure prophylaxis: Administer antiepileptic drugs to prevent seizure activity, particularly in cases of intracerebral hemorrhage.
2. Surgical Intervention:
   ● Hematoma evacuation: In cases of significant hematoma causing mass effect or neurological deterioration, surgical removal of the clot may be necessary to relieve pressure on the brain and improve outcomes.
   ● Aneurysm or AVM treatment: For subarachnoid hemorrhage caused by an aneurysm or arteriovenous malformation, surgical clipping or endovascular coiling may be performed to prevent rebleeding.
3. Blood Pressure Control:
   ● Blood pressure management is crucial in hemorrhagic stroke. The target blood pressure varies depending on the patient’s clinical condition, the location and size of the hemorrhage, and the presence of comorbidities.
   ● Antihypertensive medications may be administered cautiously to maintain blood pressure within a safe range while ensuring adequate cerebral perfusion.
4. Neurologic Monitoring:
   ● Continuous neurologic assessment is essential to detect any changes in the patient’s condition promptly. Monitoring includes Glasgow Coma Scale (GCS), pupillary response, motor function, and signs of increased intracranial pressure.
5. Prevention of Complications:
   ● Thromboembolic prophylaxis: Initiate prophylactic measures, such as subcutaneous heparin or pneumatic compression devices, to prevent deep vein thrombosis and pulmonary embolism.
   ● Temperature management: Maintain normothermia to avoid hyperthermia, which can exacerbate brain injury.

The management of hemorrhagic stroke requires a multidisciplinary approach involving neurologists, neurosurgeons, critical care specialists, and pharmacists. Close monitoring, prompt intervention, and supportive care are essential components of the comprehensive management strategy.