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Monday, 2 December 2013

Upper head hemorrhaging: Intracranial hemorrhage - The Treatments

Hemorrhaging is also known as bleeding or abnormal bleeding as a result of blood loss due to internal.external leaking from blood vessels or through the skin.
Intracranial hemorrhage
 Intracranial hemorrhage is defined as condition of bleeding within the skull.
D.1.1. Types of Intracranial hemorrhage
In the study to evaluate the sensitivity and specificity of head ultrasound (HUS) in the detection of intracranial hemorrhage in premature neonates compared with brain MRI using susceptibility-weighted imaging (SWI), showed that Ultrasound (US) and MRI scans of the brain using SWI in premature neonates were retrospectively evaluated for grade I-III germinal matrix hemorrhage (GMH), periventricular hemorrhagic infarction (PVHI), intra-axial hemorrhage other than PVHI, extra-axial hemorrhage in each cerebral hemisphere and cerebellar hemorrhage in each cerebellar hemisphere(1).
1. Intra-axial hemorrhage (cerebral hemorrhage)
Intra-axial hemorrhage is defined as a condition of  bleeding in the brain itself, including bleeding of the brain tissues and ventricles,

2. Extra-axial hemorrhage
Extra-axial hemorrhage is defined as a condition of skull bleeding outside of the brain
Treatments 
Treatments of Intracranial hemorrhage are completely depending to diseases of differentiation
1. Medication
a. Antihypertensive therapy
In the study of the efficacy of the American Heart Association/American Stroke Association guidelines for ultra-early, intentional antihypertensive therapy in intracerebral hemorrhage, showed that there are clinical benefits, by the prevention of subsequent HE, in maintaining a MAP level lower than that recommended by the the American Heart Association/American Stroke Association (AHA/ASA) (110 mm Hg) after hospitalization for patients who have intracerebral hemorrhage (ICH)(19).

b. Factor VII
Factor VII is a protein that causes blood to clot. Several studies have demonstrated successful correction of the international normalized ratio (INR) using prothrombin complex concentrate (PCC) or recombinant activated factor VII (rFVIIa). To our knowledge, no study has directly compared these agents for treatment of warfarin-related ICH(20).

c. Mannitol and hypertonic saline
In the study to develop effective strategies for the medical treatment of ICP in cases of ICH, we evaluated the therapeutic efficacy of mannitol and hypertonic saline in a canine model of ICH, found that
hypertonic saline, in both 3 and 23.4% concentrations, is as effective as mannitol in the treatment of intracranial hypertension observed in association with ICH. Hypertonic saline may have a longer duration of action, particularly when used in 3% solution. None of three treatment regimens influence regional cerebral blood flow or cerebral metabolism(21).

d. Acetaminophen to relieve the symptoms of  headache and  body temperature.

e. Corticosteroids
Corticosteroids, a synthetic drug and closely resemble cortisol, which is produced by the adrenal glands may be used in case of hypertensives and swelling.

f. Etc.

2. Non medical treatments
a. In case of intracranial pressure, placement of intracranial pressure monitors (The intracranial pressure (ICP) is monitored and ICP also can be lowered by draining cerebral spinal fluid (CSF) out through the catheter) by non-neurosurgeons: Excellent outcomes can be achieved. Placement of ICP monitors may be performed safely by both neurosurgeons and non-neurosurgeons. This procedure should thus be considered a core skill for trauma surgeons and surgical residents alike, thereby allowing initiation of prompt medical treatment in both rural areas and trauma centers with inadequate neurosurgeon or fellow coverage, according to the study by Department of Trauma Services, Via Christi Hospital on Saint Francis (J.M.H.(22).

3. Surgery
"Currently, most neurosurgeons in the UK would operate on patients with a deteriorating conscious level and a worsening neurological deficit. In addition, haematomas between 20—80 ml in volume are more likely to be operated upon as are lobar/superficial haematomas. With cerebellar haemorrhage, although there are again no randomized controlled trials comparing surgical and conservative treatment, there seems to be greater agreement that hematomas greater than 3—4 cm should be operated upon, especially when there is concomitant clinical deterioration or hydrocephalus", according to the study of Surgical treatment of intracerebral haemorrhage by University of Newcastle upon Tyne, Newcastle upon Tyne, UK (23).
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(19) http://www.ncbi.nlm.nih.gov/pubmed/20541417?dopt=Abstract
(20) http://www.ncbi.nlm.nih.gov/pubmed/21492631
(21) http://www.ncbi.nlm.nih.gov/pubmed/10232539
(22) http://www.ncbi.nlm.nih.gov/pubmed/22929484
(23) http://bmb.oxfordjournals.org/content/56/2/444.full.pdf