Walsh & Hoyt: Hemorrhagic Cerebrovascular Disease: Management

When the patient reaches the emergency with an acute neurologic event raising the possibility of a ""stroke,"" supportive measures must be taken prior to obtaining any neuroimaging. A major challenge for physicians in the emergency room is when to intubate patients. Early intubation with the use of short-acting anesthetics is necessary in patients who have a decreased level of consciousness or impairment of reflexes that protect the airway. A delay in protecting the airway can lead to secondary injury from aspiration, hypoxemia, and hypercapnia. Findings such as rapid deterioration, clinical evidence of transtentorial herniation, or hydrocephalus on CT scanning should mandate an urgent neurosurgical consultation. The use of hyperventilation and intravenous mannitol and the placement of an intraventricular catheter for the drainage of cerebrospinal fluid can preserve brain structures from mechanical and ischemic damage until surgical decompression can be performed. Mass effect. Intracranial hypertension. Elevated blood pressure. Ventricular blood. Hydrocephalus. Surgical evacuation. Hematoma. Seizures. Hemorrhage.