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Nontraumatic Intracranial Hemorrhage 

Nontraumatic Intracranial Hemorrhage
Chapter:
Nontraumatic Intracranial Hemorrhage
Author(s):

Deepak Sharma

, and Julia Metzner

DOI:
10.1093/med/9780190226459.003.0062
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date: 10 August 2020

Nontraumatic subarachnoid, intraventricular, or intraparenchymal hemorrhage can be caused by either rupture of an aneurysm or arteriovenous malformation or by coagulopathy, hypertension, or vasculitis. Pituitary apoplexy results from spontaneous hemorrhage or infarction into a pituitary tumor. Additionally, anesthesiologists must be prepared to manage intraoperative bleeding during craniotomies. Successful management of nontraumatic intracranial hemorrhage requires (1) careful preoperative evaluation and preparation considering extracranial manifestations of intracranial bleeding; (2) administration of balanced anesthesia to facilitate surgical exposure and neurophysiological monitoring; (3) maintenance of cerebral perfusion by preserving circulating volume, judicious use of blood product transfusion and vasopressors, and avoidance of excessive hyperventilation; and, when possible, (4) providing timely emergence from anesthesia to allow neurological assessment. Close communication between the surgical and anesthesia teams is critical for optimizing the potential for good patient outcomes.

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