intracranial hemorrhage

Etiology

• risk factors (see intracerebral hemorrhage)

Radiology

• CT of the head vs MRI
  • less expensive, faster, more available

Complications

• disease interaction(s) of intracranial hemorrhage with atrial fibrillation

Management

reversal of anticoagulation

• vitamin K antagonists should be reversed
  • suggested dosing is 10 mg vitamin K intravenously
  • repeat if INR > 1.4 at 24-48 hours
  • for patients with INR > 1.4, administering 3- or 4-factor prothrombin complex concentrate better than fresh frozen plasma
• oral direct factor Xa inhibitors
  • if event occurred within 3-5 1/2 lives of drug administration, 4-factor prothrombin complex concentrate should be used
• dabigatran
  • reverse with idarucizumab (Praxbind)
  • if not available, use 4-factor prothrombin complex concentrate
• therapeutic intravenous heparin
  • IV protamine at 1 mg for every 100 units of heparin administered in the past 2-3 hours (maximum dose, 50 mg)
• low-molecular-weight heparin
  • protamine
• thrombolytic therapy
  • cryoprecipitate should be administered
• antiplatelet agents
  • platelet transfusions not recommended, unless neurosurgery needed
• resuming anticoagulation after intracranial hemorrhage
  • anticoagulation can be resumed safely in most patients
  • 10% of patients resuming anticoagulation will have a recurrence of intracranial hemorrhage, some fatal

systolic blood pressure control

• target systolic blood pressure 140-160 mm Hg or mean arterial pressure = 110 mm Hg
• preferred antihypertensive agents
  • nicardipine
  • labetolol

apparently, low dose aspirin may be continued

anticonvulsants not indicated in to absence of seizure or epileptiform activity on EEG

desmopressin associated with less hemorrhage expansion in antiplatelet- associated hemorrhage but no change in clinical outcome

More general terms

• head injury
• internal hemorrhage

More specific terms

• cephalohematoma
• cerebral laceration
• cerebrovascular hemorrhage
• intracranial hematoma