Hemorrhage intracranial

The amphetamines and the anorexiants should not be given during or within 14 days after administration of monoamine oxidase inhibitors (see Chap. 31) because the patient may experience hypertensive crisis and intracranial hemorrhage. When guanethidine is administered with the amphetamines or the anorexiants, the antihypertensive effect of guanethidine may decrease. Coadministration of the amphetamines or the anorexiants with the tricyclic antidepressants may decrease the effects of the amphetamines or the anorexiants. 

D. if the amphetamine is administered within 14 days of the MAO inhibitor, an intracranial hemorrhage may occur... 

The clinical role of permeability imaging has yet to be assessed by a large clinical trial, but these techniques continue to hold promise for the future, as intracranial hemorrhage is the most significant potential complication of what is currently the only FDA-approved treatment for acute stroke. 

Clearly defined time of onset <3 h Measurable stroke-related deficit No intracranial hemorrhage on CT... 

OR 1.81, 95% Cl 1.46-2.24), most of which were related to symptomatic intracranial hemorrhage (OR 3.37, 95% Cl 2.68. 22). In addition, a pooled analysis of six major randomized placebo-controlled IV rt-PA stroke trials (Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke (ATLANTIS) I and II, European Cooperative Acute Stroke Study (ECASS) I and II, and NINDS I and II), including 2775 patients who were treated with IV rt-PA or placebo within 360 minutes of stroke onset, confirmed the beneht up to 3 hours and suggested a potential beneht beyond 3 hours for some patients. The pattern of a decreasing chance of a favorable 3-month outcome as the time interval from stroke onset to start of treatment increased was consistent with the findings of the original NINDS study. ... 

History of intracranial hemorrhage or symptoms suspicious for subarachnoid hemorrhage Major surgery within past 14 days ... 

Stenting of an acutely occluded intracranial vessel may provide fast recanalization by entrapping the thrombus between the stent and the vessel wall. A recent study in which 19 patients with acute occlusions at the ICA terminus n = 8), M1/M2 (n = 7), or basilar artery (n = 4) were treated with balloon-expandable stents showed a TIMI 2 and 3 recanalization rate of 79% and no symptomatic intracranial hemorrhages (Fig. 4.5). ... 

Khatri P, Broderick J, Khoury JC, Carrozzella J, Tomsick T, for the IMS-1 and 2 Investigators. Microcatheter contrast injections during intra-arterial thrombolysis increase intracranial hemorrhage risk. International Stroke Conference Kissimmee, Elorida 2006. 

Wylie EJ, Hein ME, Adams JE. Intracranial hemorrhage following surgical revascularization for treatment of acute strokes. J Neurosurg 1964 21 212-215. 

In the REACH smdy involving the Medical College of Georgia and five rural hospitals in Georgia, 12 of 75 (16%) patients evaluated received rt-PA, all without intracranial hemorrhagic complications. 

Evidence of intracranial hemorrhage, subarachnoid hemorrhage, or a large area of cerebral edema, parenchymal hypodensities, or sulcal effacement on pretreatment CT scan... 

Discontinue infusion and obtain emergent head CT if intracranial hemorrhage is suspected (see Table 2.6)... 

If intracranial hemorrhage is confirmed, administer 5-10 units of cryoprecipitate, evaluate laboratory results, and supplement blood products and platelets as deemed necessary (e.g., 2 units fresh frozen plasma [FFP], 6-8 units platelets)... 

Previous intracranial hemorrhage at any time ischemic stroke within 3 months... 

ICH, intracranial hemorrhage TIMI, Thrombolysis in Myocardial Blood Flow (TIMI-3 blood flow indicates complete perfusion of the infracted artery). (Reprinted from Spinier SA, de Den us S. Acute Coronary Syndromes. In DiPiro JT, Talbert RL, Yee CC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw-Hill 2005 303, with permission.)... 

Doses and contraindications to glycoprotein Ilb/IIIa receptor blockers are described in Table 5-2. Major bleeding and rates of transfusion are increased with administration of a glycoprotein Ilb/IIIa receptor inhibitor in combination with aspirin and an anticoagulant,30 but there is no increased risk of intracranial hemorrhage in the absence of concomitant fibrinolytic treatment. The risk of thrombocytopenia with tirofiban and eptifibatide appears lower than that with abciximab. Bleeding risks appear similar between agents. 

Fibrinolytics Bleeding, especially intracranial hemorrhage Clinical signs of bleeding3 baseline CBC and platelet count mental status every 2 hours for signs of intracranial hemorrhage daily CBC... 

Factors that increase the risk of bleeding must be evaluated before thrombolytic therapy is initiated (i.e., recent surgery, trauma or internal bleeding, uncontrolled hypertension, recent stroke, or intracranial hemorrhage)... 

Evidence of intracranial hemorrhage on Cl scan of the brain prior to treatment... 

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