CURRENT CRITICAL MANAGEMENT OF CURRENT CRITICAL MANAGEMENT OF
SPONTANEOUS INTRACEREBRAL SPONTANEOUS INTRACEREBRAL
HAEMORRHAGEHAEMORRHAGE (SICH)(SICH)Setyo Widi NugrohoSetyo Widi
NugrohoDepartment of Neurosurgery Department of
NeurosurgeryPadjadjaran University/Hasan Sadikin
HospitalPadjadjaran University/Hasan Sadikin Hospital Bandung
Bandung IntrodutionIntrodution!Spontaneous intraere"ral hemorrhage
#SI$H% isa"lood lot that arises in the "rainparenhyma inthea"seneof
trauma or surgery !&his entity aounts for '( to ')* of all
strokes !Higher mortality rate than either ishemi stroke or
su"arahnoid hemorrhage !+""rupt elevation of "lood pressure rupture
of small penetrating arteries Pathology , -oationPathology ,
-oation .tiology.tiology!$ommon auses
/0hypertension0amyloidangiopathy0oagulopathy0vasular
anomalies0tumors1 and 0various drugs Diagnosti ProedureDiagnosti
Proedure!Physial diagnosti +"rupt onset of onsiousness and
neurologi defiits!2adiodiagnosti / 0$& sanning /! Initial
diagnosti modality of hoie in SI$H0+ngiography ! should "e
onsidered in all ases e3ept those involving older patients 4ith
pree3isting hypertension in thalami1 putaminal1 or ere"ellar
hemorrhage 052I1 52+ $2I&I$+- 5+N+6.5.N&$2I&I$+-
5+N+6.5.N&!Initial 5anagement /0Identify site of haemorrhage
4ithin neura3is!$linial e3am!2adiodiagnosti / $& San 152I1 52+1
DS+0Prevent su"se7uent damage from re"leeding edema1 or hypo3ia8
Initial stepsInitial steps!+ir4ay, Breathing ontrol06$S 9 :
Intu"ation0P$;< / luid 5anagement /! Intavenous solution #
euvolume1 slight hyperosmolar%! 5anitol