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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Aug 4, 2015; 4(3): 213-229
Published online Aug 4, 2015. doi: 10.5492/wjccm.v4.i3.213
Steps to consider in the approach and management of critically ill patient with spontaneous intracerebral hemorrhage
Daniel Agustin Godoy, Gustavo Rene Piñero, Patricia Koller, Luca Masotti, Mario Di Napoli
Daniel Agustin Godoy, Neurocritical Care Unit, Sanatorio Pasteur, Catamarca 4700, Argentina
Daniel Agustin Godoy, Intensive Care Unit, San Juan Bautista Hospital, Catamarca 4700, Argentina
Gustavo Rene Piñero, Patricia Koller, Intensive Care Unit, Leónidas Lucero Hospital, Bahía Blanca, Buenos Aires 1427, Argentina
Luca Masotti, Internal Medicine, Santa Maria Nuova Hospital, 50134 Florence, Italy
Mario Di Napoli, Neurological Service, San Camillo de’ Lellis General Hospital, 02100 Rieti, Italy
Mario Di Napoli, Neurological Section, SMDN-Center for Cardiovascular Medicine and Cerebrovascular Disease Prevention, 67039 Sulmona, L’Aquila, Italy
Author contributions: Godoy DA designed research; Piñero GR, Koller P and Masotti L performed research; Godoy DA and Di Napoli M analyzed data; Godoy DA and Di Napoli M wrote the paper.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Daniel Agustin Godoy, Neurocritical Care Unit, Sanatorio Pasteur, Chacabuco 675, Catamarca 4700, Argentina. dagodoytorres@yahoo.com.ar
Telephone: +54-38-34432005 Fax: +54-38-34432006
Received: November 8, 2014
Peer-review started: November 9, 2014
First decision: December 26, 2014
Revised: March 3, 2015
Accepted: June 4, 2015
Article in press: June 8, 2015
Published online: August 4, 2015
Processing time: 281 Days and 20 Hours
Core Tip

Core tip: Spontaneous intracerebral hemorrhage is associated with poor outcome. Neurological deterioration and death are common in early hours, so it is a true neurological-neurosurgical emergency. Nihilism and early withdrawal of active therapy clearly influence the outcome. Action should be taken fast and accurately. Treatment should be individualized and guided preferably by pathophysiology in a multidisciplinary team work. For correct management it’s important to establish an orderly and systematic strategy based on clinical stabilization, evaluation and establishment of prognosis, avoiding secondary insults and adoption of specific individualized therapies, including hemostatic therapy and intensive control of elevated blood pressure.