Intracranial hemorrhage (ICH) is defined as bleeding within the intracranial vault and has several subtypes depending on the anatomic location of bleeding. ICH is diagnosed through history, physical examination, and, most commonly, noncontrast CT examination of the brain, which discloses the anatomic bleeding location.
Trauma is a common cause. In the absence of trauma, intracranial hemorrhage may be spontaneous, precipitated by an underlying vascular malformation, or related to therapeutic anticoagulation. The goals of critical care are to assess the proximate cause, minimize the risks of hemorrhage expansion through blood pressure control and correction of coagulopathy, and obliterate vascular lesions with a high risk of acute rebleeding.
Simple bedside scales and interpretation of computed tomography scans assess the severity of neurological injury. Fever (often not from infection) is common and can be effectively treated, although therapeutic cooling has not been shown to improve outcomes after intracranial hemorrhage. Most functional and cognitive recovery takes place weeks to months after surgery.
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