ICH guideline 2010, Enigma

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Stroke, masi jadi salah satu tantangan terbesar para neurologist, nggak ada bosennya buat dibahas.. "Teaser" supersingkat ini dibikin setelah baca2 guideline stroke perdossi 2011 n ngikutin bbrp simposium stroke. Plus, nemu sbuah artikel mnarik yg mengomentari guideline ICH 2010 ini. Yep. Ada banyak tanda tanya!
(Bisa panjang nih pembahasannya.. Eeeng, kapan2 aja deh, belajar dulu yg banyak sambil ngumpulin referensi..)
Buatku, ada 3 topik enigmatic yg paling menarik buat diexplore n dipelajari lebih lanjut, sekaligus bikin pusing: "Jadi, apa yang terbaik buat pasien saya??"
Nggak sabar ngikutin pkembangan stroke selanjutnya...

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ICH guideline 2010, Enigma

  1. 1. ICH Guideline 2010 : Enigma
  2. 2. “One would think that we would know exactly what to do by now, and we should have the pathophysiology well in hand. Unfortunately, we are left with only guidelines, which essentially are admissions that we don’t know what to do.” -- Roberts JR, 2011
  3. 3. The issues Glucose & temperature SeizureNeuroimaging control ED management Prehospitalmanagement
  4. 4. ..and the most confusing issues BP management ICP monitoring Surgery & Clot removal
  5. 5. Should we reduce BP in acute ICH? No, Yes, increased BP is increased BP is necessary harmfulIs there evidence of Hematoma expansionperihematoma ischemia?? is a reality
  6. 6. Best timing for Clot Removal Recommendation: < 7 hours, may be useful not significant(too) Early • Rebleeding 12 hour • Not significant 24 hour • Not significant 48 hour • Not significant 96 hour • Not significant No Surgery ?
  7. 7. ICP monitor in Stroke, not useful? For most patients with ICH, the Ventricular drainage as treatment forusefulness of surgery is uncertain. hydrocephalus is “reasonable”.. GCS 8 or lower, transtentorial herniation, significant IVH / hydrocephalus  “might be considered” for ICP monitoring and treatment. ..no clear evidence at present indicates that ultra-early removal of supratentorialMAP >130 + increase ICP  CPP 60 ICH improves functional out- come or mortality rate. Very early craniotomy may be harmful..
  8. 8. Conclusion : New “eye” Compare (other guidelines & literature) Keep searching
  9. 9. Enjoy the Guidelines!