Cerebral Hemorrhage: Therapy

Suspicion of intracerebral hemorrhage: call 911 immediately! (Call 112)

General measures

  • Nicotine restriction (refraining from tobacco use).
  • Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day).
  • Aim for normal weight! Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a medically supervised weight loss program.
    • BMI ≥ 25 → participation in a medically supervised weight loss program.
  • Review of permanent medication due topossible effect on the existing disease.

Stroke Unit – for small intracerebral hemorrhage

The patient should be observed in a stroke unit. Blood pressure must be controlled and hemorrhage progression (progression of cerebral hemorrhage) prevented.The following values are monitored there:

  • Respiration
  • Blood pressure
  • Heart rate
  • Glucose (blood sugar)
  • Electrolytes
  • Blood clotting
  • Body temperature

Supportive therapy – for large intracerebral hemorrhage

Airway management (ventilation)

  • Pulse oximetry-measured oxygen saturation (SpO2) should be >90%.
  • Patients with severe sepsis/septic shock should be ventilated early.
  • The following parameters should be maintained:Controlled ventilation:
    • Tidal volume (breath volume, or AZV; is the set volume applied per breath): 6 ml/kg standard body weight
    • Plateau pressure (measure of end-inspiratory pressure in alveoli in a flow-free phase): < 30 cm H2O.
    • Oxygen saturation (SpO2): > 90%.
  • PEEP (engl. : positive end-expiratory pressure; positive end-expiratory pressure) as a function of FiO2 (indicates how high the O2 content in the breathing air is).
  • In severe oxygenation disorders, prone positioning or 135° positioning should be performed.
  • Weaning (English : to wean; or ventilator weaning is the phase of weaning a ventilated patient from the ventilator) should be started as soon as possible.

The following additional therapeutic measures may be considered:

  • If the affected person permanently takes anticoagulants/anticoagulants → coagulation compensation (see below “Drug therapy/pharmacotherapy”).
  • If occlusive hydrocephalus (hydrocephalus occlusus; pathological/diseased dilatation of the fluid-filled fluid spaces (cerebral ventricles) of the brain) is present → installation of a ventricular drainage device (EVD) (see “Surgical therapy” below)
  • Possibly hematomevacuation (hematoma evacuation) (see “Surgical therapy” below).
  • Cerebral pressure-lowering measures (see “Drug therapy/pharmacotherapy” below).

Physical therapy (incl. physiotherapy)

Rehabilitation

  • Early rehabilitation (begins after a few days) – consisting of:
    • Physiotherapy
    • Speech therapy
    • Occupational therapy