Fast Five Quiz: Test Your Knowledge on Key Aspects of Hemorrhagic Stroke

Amy Kao, MD

Disclosures

May 10, 2018

Placement of an intraventricular catheter for cerebrospinal fluid drainage (ie, ventriculostomy) is often used in the setting of obstructive hydrocephalus, which is a common complication of thalamic hemorrhage with third-ventricle compression and of cerebellar hemorrhage with fourth-ventricle compression. Ventriculostomies are associated with a risk for infection, including bacterial meningitis.

In patients with cerebellar hemorrhage, surgical intervention has been shown to improve outcome if the hematoma is >3 cm in diameter. It can be lifesaving in the prevention of brainstem compression. A meta-analysis of trials for surgical treatment of spontaneous supratentorial intracerebral hemorrhage found evidence for improved outcome with surgery if any of the following applied:

  • Surgery undertaken within 8 hours of ictus

  • Volume of the hematoma 20-50 mL

  • Glasgow coma score 9-12

  • Patient age 50-69 years

Endovascular treatment of aneurysms may be favored over surgical clipping under the following circumstances:

  • The aneurysm is in a location that is difficult to access surgically, such as the cavernous internal carotid artery or the basilar terminus

  • The aneurysm is small-necked and located in the posterior fossa

  • The patient is elderly

  • The patient has a poor clinical grade

Although vasospasm may be treated with intra-arterial pharmaceutical agents, such as verapamil or nicardipine, balloon angioplasty can be used for opening larger vessels. The combination of the two treatments appears to provide safe and long-lasting therapy for severe, clinically significant vasospasm.

For more on invasive treatment of hemorrhagic stroke, read here.

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