Critical care of subarachnoid and intracerebral hemorrhage

Intensive care plays an important role in the management of subarachnoid and intracerebral hemorrhage. Aggressive intensive care unit-based management protocols for stuporous or comatose patients with subarachnoid hemorrhage, including early aneurysm obliteration and hemodynamic augmentation to treat ischemia from vasospasm, have been shown to increase survival dramatically. Endovascular occlusion of acutely ruptured aneurysms has been shown to prevent early rebleeding and is a promising option for patients who cannot undergo early surgical clipping due to the complexity of their aneurysm or medical comorbidity. Early neurologic deterioration in patients with hypertensive intracerebral hemorrhage has been shown to result from progressive hematoma expansion, which occurs in 30% of patients presenting within 3 hours of onset. Studies of the effects of standard critical care interventions such as blood pressure reduction on early intracerebral hemorrhage growth are needed.