Neurocritical Care Review Course-Hemorrhagic Stroke

Video Transcription

Video Summary

In this video, Dr. Deepa Malliandy provides a high-yield review of hemorrhagic stroke and updates in management. She begins by discussing the goals of the talk, which include determining early blood pressure control targets, identifying imaging patterns associated with increased risk of hematoma expansion, weighing the risks and benefits of antithrombotic reversal and hemostatic treatments, and identifying patients for urgent surgical treatment.<br /><br />Dr. Malliandy explains the terminology and etiologies of hemorrhagic stroke, including primary and secondary causes. She then discusses the principles of management, including blood pressure control targets based on the Interact2 and Attach2 trials. She emphasizes the importance of continuous, smooth, and sustained blood pressure control, with initial treatment within two hours of symptom onset.<br /><br />The video also covers imaging patterns associated with hematoma expansion, such as the spot sign, black hole sign, and swirl sign. Dr. Malliandy explains the significance of these signs and their potential correlation with hematoma expansion and poor outcomes.<br /><br />The video addresses the reversal of coagulopathic states, such as an elevated INR or prolonged APTT. Dr. Malliandy discusses the PATCH trial, which found that platelet transfusion was associated with increased odds of death and dependence. However, she notes that there may be subgroups of patients who may still benefit from platelets or other treatments, and future research is needed to clarify this.<br /><br />The video concludes by discussing treatment options for patients who require surgical intervention, such as intrathecal thrombolytics and craniotomy. Dr. Malliandy emphasizes the importance of a multidisciplinary approach and individualized management based on the specific characteristics of each patient.<br /><br />Overall, the video provides a comprehensive overview of hemorrhagic stroke and updates in management, highlighting key principles and considerations for clinicians.

Asset Caption

Deepa Malaiyandi, MD

Keywords

hemorrhagic stroke

management

blood pressure control targets

hematoma expansion

imaging patterns

reversal of coagulopathic states

surgical treatment

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