ACUTE TREATMENT of BRAIN BLEEDS
Once the diagnosis of acute brain bleed is made in the Emergency Department, the main aim is to assess the degree of irreversible damage and take appropriate measures to limit loss of function. If the patient's level of consciousness is decreased to the point of compromising the safety of airway and breathing, the patient is intubated and started on mechanical ventilation.
The value of surgery is not established for intraparenchymal hemorrhage (bleeding into the brain tissue) and surgical evacuation is used in situations the treating physicians perceive a benefit from intervention. For other types of brain bleeds such as subdural hemorrhage, evacuation of the bleed is performed more routinely. Many different parameters factor in the decision to evacuate or not evacuate a brain bleed. Both open surgical and minimally invasive approaches are available. Surgery might be of value in helping achieve a better functional outcome but there might also be situations where surgery saves the patient's life while making him/her bedridden or completely dependent for the rest of his/her life. A detailed discussion between the treating physician teams and the patient/family helps to optimize management approaches, incorporating the patient's wishes into the therapeutic plans.
In special situations such as finding an aneurysm or arteriovenous malformation, prompt treatment of these vascular pathologies can prevent re-bleeding. The management of subarachnoid hemorrhage is a special case, involving not only prompt treatment of the aneurysm (if found) but also careful monitoring for and immediate treatment of multiple possible complications such as vasospasm.
Other than surgery, patients with acute brain bleeds are carefully monitored, mostly in intensive care units, to monitor for medical/surgical complications and their immediate treatment. Identification and treatment of infectious issues, seizures, and systemic/metabolic abnormalities can improve outcomes. The value of the management of blood pressure and blood glucose levels are also intensely debated topics in the management of acute ICH patient.
Overall, the needs of the individual patient vary tremendously and close communication between the patient/family and providers is very important for optimal care delivery.