Actualización en el manejo de la hemorragia intracerebral espontánea

Dr. Pablo Odio Zúñiga, Dr. Francisco Huete Montealegre, Dr. Álvaro Hernández Guillén, Dr. Emmanuel Martínez Martínez, Dr. Miguel Ángel Barboza Elizondo

Resumen


La hemorragia intracerebral se encuentra entre las principales causas de discapacidad y muerte en el mundo, sin embargo, la mayoría de las recomendaciones de manejo tienen un nivel de evidencia bajo. En general, el manejo de la hemorragia intracerebral consiste en lo siguiente: evitar la hipertensión intracraneal y la hipertensión arterial, prevenir la expansión del hematoma, valorar la necesidad de drenaje quirúrgico y tratar las complicaciones asociadas.

El manejo debe ser en unidad de Ictus, inicialmente tomando en cuenta las medidas de estabilización hemodinámica y ventilatoria. En cuanto a la hipertensión arterial, es recomendable el alcance y mantenimiento de la presión arterial sistólica por debajo de 140 mmHg. En el paciente anticoagulado con warfarina se debe realizar la reversión de la anticoagulación, preferiblemente con factor protrombínico. En el paciente no anticoagulado no hay evidencia suficiente de que medidas hemostásicas ofrezcan algún beneficio.

La indicación de manejo quirúrgico en hemorragia intracerebral siempre ha sido controversial.  Las técnicas mínimamente invasivas parecen ofrecer un beneficio terapéutico en comparación a las técnicas clásicas. La trombólisis intraventricular también es otra opción potencialmente terapéutica y segura

Palabras clave


manejo de la hemorragia intracerebral, Ictus

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Referencias


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