Intracranial & Subarachnoid Hemorrhage

Dr. Neeraj Badjatia is the director of the neurosurgery critical care unit at the University of Maryland and a world expert in the field of neurocritical care, publishing 85+ peer-reviewed journals on the subject. In this lecture, Dr. Badjatia will discuss subarachnoid bleeds and intracerebral hemorrhages, with a focus on the initial assessment of patients, long-term prognosis, and on management of both volume status and electrolyte disturbances.

MarylandCCProject – SAH and ICH.mp3

Pearls

1. Using the Hunt and Hess Scale coupled with the Fisher Scale for subarachnoid hemorrhages one can predict both the morbidity and mortality as well as the risk for vasospasm immediately upon arrival to the ED or ICU.
2. For intracerebral hemorrhage, the FUNC score can help predict the 90 day likelihood of functional independence.
3. There is no benefit to hypervolemia in these disease states. The goal for any intracranial hemorrhage is to maintain euvolemia with isotonic solutions, D5W and 1/2NS has no place in the NeuroICU.
4. In order to properly treat hyponatremia, it is important to determine the volume status of the patient. Hypervolemia is indicative of SIADH, where cerebral salt wasting is accompanied by hypovolemia and a rise in uric acid levels.
5. The functional outcome of patients, as measured by the Modified Rankin Scale, is significantly decreased by anemia, hyperglycemia and hyperthermia.  Avoidance of all three is the goal of the neurointensivist.