Ictus emorragico

Question 1

Fattori di rischio

Answer 1

For both ischemic and hemorrhagic strokes, age is the most important nonmodifiable risk factor and arterial hypertension is the most important modifiable risk factor!

Question 2

Neurologic complications

Answer 2

• Recurrent hemorrhage (risanguinamento, prima 24 ore o dopo 1-2 settimane. Il miglior modo per evitare un risanguinamento è escludere l’aneurisma dalla circolazione mediante embolizzazione o clipping chirurgico)
• Intraventricular hemorrhage
• Hydrocephalus (in forma acuta dopo 24/48 ore ma anche dopo alcune settimane. Questo idrocefalo è di tipo comunicante non ostruttivo: aprassi della marcia, alterazione degli sfinteri e demenza reversibile)
• Vasospasm (typicallyPrevenzione occurs 5–7 days after SAH) → may result in ischemic stroke. Prevenzione mediante la somministrazione di nefedipina e tripla terapia : emodiluizione, ipervolemia e ipertensione, che però aumenta il rischio di risanguinamento)

Question 3

Blood pressure management

Answer 3

Reduce systolic blood pressure to approx. 140–160 mm Hg

NB Nitrates should be avoided because they can increase intracranial pressure (Nitroglycerin was given intravenously to five anesthetized, hyperventilated (PaCO2 25 to 30 torr) patients during craniotomy, to facilitate surgery by creating a relatively bloodless field, and to decrease the potential need to blood transfusion. A subarachnoid screw and an indwelling radial artery catheter were inserted to monitor intracranial pressure (ICP) and mean arterial pressure (MAP). As MAP decreased from 10.4 +/- 4.0 (SE) to 69.0 +/- 1.8 torr, ICP increased from 14.2 +/- 0.7 (SEM) to 30.8 +/- 1.1 torr. Cerebral perfusion pressure decreased from 90.2 +/- 3.6 (SEM) to 38.2 +/- 2.3 torr (p < 0.0005). We attribute this nitroglycerin-induced ICP increase to capacitance vessel dilation within the relatively noncompliant cranial cavity, with subsequent cerebral blood volume increase)