Avaliação e Abordagem do Doente com Hemorragia Intracerebral Espontânea: Artigo de Revisão

Autores

  • João Tavares Serviço de Medicina Interna, Centro Hospitalar de Setúbal, Setúbal, Portugal https://orcid.org/0000-0002-5207-9561
  • Patrícia Carneiro Serviço de Medicina Interna, Centro Hospitalar de Setúbal, Setúbal, Portugal https://orcid.org/0000-0003-3820-3439
  • Mário Parreira Serviço de Medicina Interna, Centro Hospitalar de Setúbal, Setúbal, Portugal
  • Ermelinda Pedroso Serviço de Medicina Interna, Centro Hospitalar de Setúbal, Setúbal, Portugal

DOI:

https://doi.org/10.24950/R/54/21/3/2021

Palavras-chave:

Acidente Vascular Cerebral, Hemorragias Intracranianas, Hipertensão Intracraniana, Pressão Intracraniana

Resumo

A hemorragia intracraniana espontânea afeta anualmente mais de 1 milhão de pessoas, representando 9% a 27% do total de acidentes vasculares cerebrais a nível mundial, e apresenta uma elevada taxa de mortalidade e morbilidade. Tratando-se de uma emergência médica, o rápido diagnóstico e instituição de medidas terapêuticas com impacto reconhecido na mortalidade e morbilidade é fundamental. Este artigo pretende, à luz das recomendações mais recentes e dados mais relevantes publicados na literatura, rever a abordagem diagnóstica e terapêutica médica dos doentes com hemorragia intracraniana espontânea. Após o rápido diagnóstico, a utilização de escalas de gravidade é fundamental para a estratificação do risco e definição da estratégia terapêutica mais adequada, seja a nível de terapêutica médica, como da eventual indicação cirúrgica emergente. As intervenções médicas na hemorragia intracraniana podem dividir- se em primárias e secundárias, consoante o timing da sua instituição. As primárias assentam no controlo rápido e agressivo da tensão arterial, correção da coagulopatia e avaliação/intervenção neurocirúrgica. As intervenções secundárias incluem o controlo da temperatura corporal, manutenção da normoglicemia, monitorização hemodinâmica, do estado de consciência e da pressão intracraniana. Concomitantemente com a abordagem terapêutica, devem ser iniciadas diligências no sentido de orientar o doente para o local mais adequado à gravidade do seu quadro, já que atrasos nesta definição estão associados a pior prognóstico clínico. Assim com este artigo pretende criar-se uma ferramenta auxiliar na otimização da prestação de cuidados aos doentes admitidos com hemorragia intracraniana.

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Publicado

21-09-2021

Como Citar

1.
Tavares J, Carneiro P, Parreira M, Pedroso E. Avaliação e Abordagem do Doente com Hemorragia Intracerebral Espontânea: Artigo de Revisão. RPMI [Internet]. 21 de Setembro de 2021 [citado 6 de Julho de 2022];28(3):288-9. Disponível em: https://revista.spmi.pt/index.php/rpmi/article/view/138

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