Avaliação e Abordagem do Doente com Hemorragia Intracerebral Espontânea: Artigo de Revisão
DOI:
https://doi.org/10.24950/R/54/21/3/2021Palavras-chave:
Acidente Vascular Cerebral, Hemorragias Intracranianas, Hipertensão Intracraniana, Pressão IntracranianaResumo
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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Referências
Dastur CK, Yu W. Current management of spontaneous intracerebral haemorrhage. Stroke Vasc Neurol. 2017;2:21-9.
Martini SR, Flaherty ML, Brown WM, Haverbusch M, Comeau ME, Sauerbeck LR, et al. Risk factors for intracerebral hemorrhage differ according to hemorrhage location. Neurology. 2012;79:2275-82.
Steiner T, Al-Shahi Salman R, Beer R, Christensen H, Cordonnier C, Csiba L, et al. European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage. Int J Stroke. 2014;9:840-55.
Krishnamurthi RV, Feigin VL, Forouzanfar MH, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet Glob Health. 2013;1:e259-81.
de Oliveira Manoel AL, Goffi A, Zampieri FG, Turkel-Parrella D, Duggal A, Marotta TR, et al. The critical care management of spontaneous intracranial hemorrhage: a contemporary review. Critical Care. 2016;20:272.
Claude Hemphill J, 3rd, Lam A. Emergency Neurological Life Support: Intracerebral Hemorrhage. Neurocrit Care. 2017;27:89-101.
van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. 2010;9:167-76.
Poon MT, Fonville AF, Al-Shahi Salman R. Long-term prognosis after intracerebral haemorrhage: systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2014;85:660-7.
Hemphill JC, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage. Stroke. 2015;46:2032-60.
Rodriguez-Luna D, Piñeiro S, Rubiera M, Ribo M, Coscojuela P, Pagola J, et al. Impact of blood pressure changes and course on hematoma growth in acute intracerebral hemorrhage. Eur J Neurol. 2013;20:1277-83.
Smith SD, Eskey CJ. Hemorrhagic stroke. Radiol Clin North Am. 2011;49:27-45.
Hemphill JC, 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001;32:891-7.
Orito K, Hirohata M, Nakamura Y, Takeshige N, Aoki T, Hattori G, et al. Leakage Sign for Primary Intracerebral Hemorrhage: A Novel Predictor of Hematoma Growth. Stroke. 2016;47:958-63.
Moon JS, Janjua N, Ahmed S, Kirmani JF, Harris-Lane P, Jacob M, et al. Prehospital neurologic deterioration in patients with intracerebral hemorrhage. Crit Care Med. 2008;36:172-5.
Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, et al. The ABCs of measuring intracerebral hemorrhage volumes. Stroke. 1996;27:1304-5.
Wada R, Aviv RI, Fox AJ, Sahlas DJ, Gladstone DJ, Tomlinson G, et al. CT angiography spot sign predicts hematoma expansion in acute intracerebral hemorrhage. Stroke. 2007;38:1257-62.
Goldstein JN, Fazen LE, Snider R, Schwab K, Greenberg SM, Smith EE, et al. Contrast extravasation on CT angiography predicts hematoma expansion in intracerebral hemorrhage. Neurology. 2007;68:889-94.
Sakamoto Y, Koga M, Yamagami H, Okuda S, Okada Y, Kimura K, et al. Systolic blood pressure after intravenous antihypertensive treatment and clinical outcomes in hyperacute intracerebral hemorrhage: the stroke acute management with urgent risk-factor assessment and improvement-intracerebral hemorrhage study. Stroke. 2013;44:1846-51.
Zazulia AR, Diringer MN, Videen TO, Adams RE, Yundt K, Aiyagari V, et al. Hypoperfusion without ischemia surrounding acute intracerebral hemorrhage. J Cereb Blood Flow Metab. 2001;21:804-10.
Butcher KS, Jeerakathil T, Hill M, Demchuk AM, Dowlatshahi D, Coutts SB, et al. The Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial. Stroke. 2013;44:620-6.
Anderson CS, Heeley E, Huang Y, Wang J, Stapf C, Delcourt C, et al. Rapid Blood-Pressure Lowering in Patients with Acute Intracerebral Hemorrhage. New England Journal of Medicine. 2013;368:2355-65.
Anderson CS, Huang Y, Wang JG, Arima H, Neal B, Peng B, et al. Intensive blood pressure reduction in acute cerebral haemorrhage trial
(INTERACT): a randomised pilot trial. Lancet Neurol. 2008;7:391-9.
Qureshi AI. Antihypertensive treatment of acute cerebral hemorrhage. Crit Care Med. 2010;38:637-48.
Anderson CS, Huang Y, Arima H, Heeley E, Skulina C, Parsons MW, et al. Effects of early intensive blood pressure-lowering treatment on the growth of hematoma and perihematomal edema in acute intracerebral hemorrhage: the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT). Stroke. 2010;41:307-12.
Qureshi AI, Palesch YY, Barsan WG, Hanley DF, Hsu CY, Martin RL, et al. Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage. New Engl J Med. 2016;375:1033-43.
Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, et al. Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation. New Engl J Med. 2011;365:883-91.
Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al. Dabigatran versus Warfarin in Patients with Atrial Fibrillation. New Engl J Med. 2009;361:1139-51.
Granger CB, Alexander JH, McMurray JJV, Lopes RD, Hylek EM, Hanna M, et al. Apixaban versus Warfarin in Patients with Atrial Fibrillation. New Engl J Med.2011;365:981-92.
Giugliano RP, Ruff CT, Braunwald E, Murphy SA, Wiviott SD, Halperin JL, et al. Edoxaban versus Warfarin in Patients with Atrial Fibrillation. New Engl J Med. 2013;369:2093-104.
Frontera JA, Lewin JJ, 3rd, Rabinstein AA, Aisiku IP, Alexandrov AW, Cook AM, et al. Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage: A Statement for Healthcare Professionals from the Neurocritical Care Society and Society of Critical Care Medicine. Neurocrit Care. 2016;24:6-46.
Baharoglu MI, Cordonnier C, Al-Shahi Salman R, de Gans K, Koopman MM, Brand A, et al. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. Lancet. 2016;387:2605-13.
Raval AN, Cigarroa JE, Chung MK, Diaz-Sandoval LJ, Diercks D, Piccini JP, et al. Management of Patients on Non-Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association. Circulation.
;135:e604-e33.
Dabi A, Koutrouvelis AP. Reversal Strategies for Intracranial Hemorrhage Related to Direct Oral Anticoagulant Medications. Critical Care Research and Practice. 2018;2018:4907164.
Pollack CV, Reilly PA, van Ryn J, Eikelboom JW, Glund S, Bernstein RA, et al. Idarucizumab for Dabigatran Reversal — Full Cohort Analysis. New Engl J Med. 2017;377:431-41.
Connolly SJ, Milling TJ, Eikelboom JW, Gibson CM, Curnutte JT, Gold A, et al. Andexanet Alfa for Acute Major Bleeding Associated with Factor Xa Inhibitors New Engl J Med. 2016;375:1131-41.
Schulman S, Bijsterveld NR. Anticoagulants and their reversal. Transfus Med Rev. 2007;21:37-48.
Passero S, Ciacci G, Ulivelli M. The influence of diabetes and hyperglycemia on clinical course after intracerebral hemorrhage. Neurology. 2003;61:1351-6.
Finfer S, Chittock D, Li Y, Foster D, Dhingra V, Bellomo R, et al. Intensive versus conventional glucose control in critically ill patients with traumatic brain injury: long-term follow-up of a subgroup of patients from the NICE--SUGAR study. Intensive Care Med. 2015;41:1037-47.
Becker KJ, Baxter AB, Bybee HM, Tirschwell DL, Abouelsaad T, Cohen WA. Extravasation of radiographic contrast is an independent predictor of death in primary intracerebral hemorrhage. Stroke. 1999;30:2025-32.
Greer DM, Funk SE, Reaven NL, Ouzounelli M, Uman GC. Impact of fever on outcome in patients with stroke and neurologic injury: a comprehensive meta-analysis. Stroke. 2008;39:3029-35.
Schwarz S, Häfner K, Aschoff A, Schwab S. Incidence and prognostic significance of fever following intracerebral hemorrhage. Neurology. 2000;54:354-61.
den Hertog HM, van der Worp HB, van Gemert HM, Algra A, Kappelle LJ, van Gijn J, et al. The Paracetamol (Acetaminophen) In Stroke (PAIS) trial: a multicentre, randomised, placebo-controlled, phase III trial. Lancet Neurol. 2009;8:434-40.
Lord AS, Karinja S, Lantigua H, Carpenter A, Schmidt JM, Claassen J, et al. Therapeutic temperature modulation for fever after intracerebral hemorrhage. Neurocrit Care. 2014;21:200-6.
Dennis M, Sandercock PA, Reid J, Graham C, Murray G, Venables G, et al. Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial. Lancet. 2009;373:1958-65.
Lacut K, Bressollette L, Le Gal G, Etienne E, De Tinteniac A, Renault A, et al. Prevention of venous thrombosis in patients with acute intracerebral hemorrhage. Neurology. 2005;65:865-9.
Nyquist P, Bautista C, Jichici D, Burns J, Chhangani S, DeFilippis M, et al. Prophylaxis of Venous Thrombosis in Neurocritical Care Patients: An Evidence-Based Guideline: A Statement for Healthcare Professionals from the Neurocritical Care Society. Neurocrit Care. 2016;24:47-60.
De Herdt V, Dumont F, Hénon H, Derambure P, Vonck K, Leys D, et al. Early seizures in intracerebral hemorrhage: incidence, associated factors, and outcome. Neurology. 2011;77:1794-800.
Bladin CF, Alexandrov AV, Bellavance A, Bornstein N, Chambers B, Coté R, et al. Seizures after stroke: a prospective multicenter study. Arch Neurol. 2000;57:1617-22.
Passero S, Rocchi R, Rossi S, Ulivelli M, Vatti G. Seizures after spontaneous supratentorial intracerebral hemorrhage. Epilepsia.
;43:1175-80.
Naidech AM, Garg RK, Liebling S, Levasseur K, Macken MP, Schuele SU, et al. Anticonvulsant use and outcomes after intracerebral hemorrhage. Stroke. 2009;40:3810-5.
Messé SR, Sansing LH, Cucchiara BL, Herman ST, Lyden PD, Kasner SE. Prophylactic antiepileptic drug use is associated with poor outcome following ICH. Neurocrit Care. 2009;11:38-44.
Ragland J, Lee K. Critical Care Management and Monitoring of Intracranial Pressure. J Neurocrit Care. 2016;9:105-12.
Carney N, Totten AM, O´Reilly C, Ullman JS, Hawryluk GW, Bell MJ, et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery. 2017;80:6-15.
Mayer SA, Chong JY. Critical care management of increased intracranial pressure. J Intensive Care Med. 2002;17:55-67.
Latorre JG, Greer DM. Management of acute intracranial hypertension: a review. Neurologist. 2009;15:193-207.
Wagner I, Hauer EM, Staykov D, Volbers B, Dörfler A, Schwab S, et al. Effects of continuous hypertonic saline infusion on perihemorrhagic edema evolution. Stroke. 2011;42:1540-5.
Kamel H, Navi BB, Nakagawa K, Hemphill JC, 3rd, Ko NU. Hypertonic saline versus mannitol for the treatment of elevated intracranial
pressure: a meta-analysis of randomized clinical trials. Crit Care Med. 2011;39:554-9.
Kollmar R, Staykov D, Dörfler A, Schellinger PD, Schwab S, Bardutzky J. Hypothermia reduces perihemorrhagic edema after intracerebral hemorrhage. Stroke. 2010;41:1684-9.
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Direitos de Autor (c) 2021 Revista da Sociedade Portuguesa de Medicina Interna
Este trabalho encontra-se publicado com a Licença Internacional Creative Commons Atribuição 4.0.
Direitos de Autor (c) 2023 Medicina Interna
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