jr update in ich

8/17/2019 JR Update in ICH

1/11

Journal Reading

Aditya Wicaksono Putra - 112015078Kepaniteraan Klinik Bagian ara!

R "ardi Ra#ayu$ Kudus


2/11

%ntroduction

%ntracere&ral #e'orr#age is a neurological e'ergency(

"edical care &egins )it# sta&ili*ation AB+

!ollo)ed &y speci,c 'easures ai'ed to decreasesecondary neurological da'age and to preent &ot#'edical and neurological co'plications(

Blood pressure 'anage'ent can &e key and continues

as an area o! de&ate and ongoing researc#( .oncontrast #ead co'puteri*ed to'ograp#y /+ scan

is t#e standard diagnostic tool(


3/11

%.RA+RBRA3 4"RR4A6

%+4 is de,ned as &leeding in t#e &rain parenc#y'a$ re!ers to any&leeding )it#in t#e cranial ault(

#is stroke su&type accounts !or a&out 10 o! all strokes

rau'atic %+4 is 'ost co''on type o! %+4

%ntracere&ral #e'orr#age occurs t)ice as co''on as A4 and iseually as deadly

#is reie) )ill !ocus on spontaneous$ nontrau'atic %+4$ i'plying&leeding t#at occurs )it#out trau'a or kno)n &leeding causes9

an arterioenous 'al!or'ation$

cere&ral aneurys'

tu'or(


4/11

%+4 is de,ned &y its location )it#in t#e &rainparenc#y'a

::deep;; or ganlionic /


5/11

pide'iology

%+4 is t)ice as co''on as aneurys'al A4

#e incidence o! %+4 is 12 to 15 cases = 100 000indiiduals or a&out >0 000 cases =year in ?

%ncidence aries a'ong populations

Japanese #ae t#e #ig#est incidence /@0 o! 100 000

!ollo)ed &y A!rican A'ericans /t)ice t#e incidence(

#is correlates )it# t#e population;s incidence o!#ypertension /4.


6/11

RISK FACTORS FOR ICH

4ypertension • 'ost co''on attri&uta&le risk !actor• it accelerates age-related ::)ear and

tear;; o! cere&ral arterioles at &ranc#points

+ere&ral A'yloid Angiopat#y • increases )it# age$ is t#e second'ost co''on risk !actor

• /Apo genotype plays an i'portantrole in t#e pat#ogenesis o! +AA

Adanced Age • #ig#est at and a!ter t#e age o! 85

Anticoagulan %ntensity • War!arin risk o! %+4 2 to 5 ti'es$• risk is directly related to

anticoagulation intensity

• 'ost )ar!arin-associated %+4 casesoccur during in t#e t#erapeutic range

• a&igatran

3eukoaraiosis or W#ite "atterisease

• its association )it# arterial 4.• #e presence o! W" in %+4 patients

is associated )it# larger #e'ato'aolu'e and #e'ato'a epansion


7/11

RISK FACTORS FOR ICH

+#ronic Kidney isease independently associated )it# &ot#isc#e'ic and #e'orr#agic stroke$ C

i'plications !or preention are still to &edeter'ined(

Alco#ol +onsu'ption 'ec#anis's are coagulopat#y andincreased systolic &lood pressure

rug A&use i'portant risk !actor in adoles- cents andyoung adults(a'p#eta'ine$ cocaine$ #eroin$ and ecstasy

3o) +#olesterol #ig#er rates o! %+4 )ere noted in

participants )it# lo)er c#olesterol leels

Prior troke or %+4

4e'atologic A&nor'alities

rau'a and Dalls

Aneurys'=Easkular "al!or'ations


8/11

Pat#op#ysiology

.ontrau'atic &leeding into t#e &rainparenc#y'a results !ro' rupture o! s'allpenetrating arteries

%n deep #e'ato'as$ t#is #as &een attri&uted todegeneratie c#anges in t#e essel )allassociated )it# adancing age$ c#ronic 4.$dia&etes$ and ot#er ascular risk !actors


9/11


10/11

reat'ent

1( 4e'ostatic #erapy

2( Blood Pressure

( urgical %nterention


11/11

+onclution

%+4 diagnosis and treat'ent #ae eoled oert#e past decade$ in t#e setting o! increasingkno)ledge a&out risk !actors$ pat#op#ysiology$

and 'anage'ent(

"icro&leeds detected &y "R% 'ay #elp predictunderlying pat#op#ysiology and #elp deter'ineprognosis(

jr update in ich

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