This document provides guidance on managing acute stroke in the emergency department. It notes that stroke is a leading cause of death worldwide and causes disability and impacts daily life. There are two main types of stroke: ischemic (70-85% of cases) and hemorrhagic (15-30% of cases). It then discusses signs and symptoms of stroke, definitions, epidemiology, diagnosis through history, neurological exam, imaging, and lab tests. Management principles focus on stabilizing vital functions, restoring cerebral blood flow, preventing complications and progression, controlling risk factors, and rehabilitation. Timely treatment is important to minimize neurological deficits.

1. SIAP TANGANI STROKE DI IGD
ESDRAS ARDI PRAMUDITA
RS PANTI RAPIH YOGYAKARTA
2022

2. • Stroke penyebab kematian ke-3 di berbagai negara
• Penyebab kecacatan dan berdampak besar pada aktivitas harian, sosial dan
ekonomi.
• Jenis stroke:
1. Perdarahan : insiden 15-30 % (Intrakranial dan subarakhnoid)
2. Iskemik : insiden 70-85 %
APA ITU
STROKE?
Stroke merupakan “serangan otak”. Dapat terjadi pada siapa saja tetapi rata-rata yang terserang berusia 70 tahun. Ada
dua jenis stroke yang dikenal yaitu stroke iskemik dan stroke hemoragik/perdarahan.
Stroke iskemik terjadi ketika aliran darah ke salah satu
area otak terhenti. Ketika ini terjadi, sel otak kekurangan
oksigen dan mulai rusak lalu mati. Ketika sel otak mati
saat stroke, kemampuan otak pada area tersebut seperti
memori dan kontrol otot akan menghilang.
STROKE ISKEMIK STROKE HEMORAGIK
Stroke hemoragik terjadi hanya sekitar 15% dari kasus
dan terjadi saat pecahnya pembuluh darah di otak,
menyebabkan kebocoran darah ke dalam otak. Otak
sendiri berada di dalam rongga tengkorak, kebocoran
darah tadi menyebabkan penekanan pada jaringan otak
EPIDEMIOLOGI

3. DEFINISI WHO 1986
Gangguan fungsional otak fokal
maupun global yang terjadi
secara akut, berasal dari
gangguan aliran darah otak .
Termasuk di sini perdarahan
subarachnoid, perdarahan
intraserebral dan iskemik atau
infark serebri.
Tidak termasuk disini gangguan
peredaran darah otak sepintas,
tumor otak, infeksi atau stroke
sekunder karena trauma

4. KASUS
Laki-laki 45 tahun, 5 jam SMRS mengeluhkan mendadak wajah perot dan
bicara pelo disertai dengan kelemahan ½ badan bagian kanan, OS memiliki
Riwayat hipertensi terkontrol dengan Candesartan dan Riwayat DM dengan
pengobatan metformin tidak rutin.
Apakah ini kasus stroke?Y/N

5. PENEGAKAN DIAGNOSIS
¡ ANAMNESIS
¡ PEMERIKSAAN NEUROLOGI
¡ PEMERIKSAAN RADIOLOGI CT SCAN KEPALA
¡ PEMERIKSAAN LABORATORIUM

6. FOKUS ANAMNESIS
¡ ONSET
¡ GEJALA STROKE
¡ FAKTOR RISIKOVASKULAR

7. PEMERIKSAAN NEUROLOGI
¡ HEMIDEFISIT MOTORIK
¡ KETERLIBATAN NN CRANIAL
¡ HEMIDEFISIT SENSORIK
¡ PENURUNAN KESADARAN
¡ GANGGUANVISUS ATAU LAPANGAN PANDANG
¡ COGNITIVE IMPAIRMENT

9. OKLUSI PADA PEMBULUH DARAH BESAR
Large vessel occlusions present with recognizable syndromes.
https://emcrit.org/emcrit/acute-ischemic-stroke-1/
ANTERIOR CIRCULATION LVO (MCA +
SYNDROME)
POSTERIOR CIRCULATION LVO (BASILAR +
SYNDROME)
- KONTRALATERALWAJAH, KELEMAHAN
EXTREMITAS
- DEVIASI GAZE (MELIHAT KEARAH HEMISFER
YANG ISKEMIK)
- AFASIA (L-MCA) OR NEGLECT (R-MCA)
- PENURUNAN KESADARAN AKUT
- GAZE PALSY ( INABILITY TO MOVE EYES)
- GANGGUAN SENSORIK.KELEMAHAN
UNILATERAL CROSSED
- VERTIGO,ATAXIA, INBALANCE (CEREBELAR
SIGN)

10. PEMERIKSAAN RADIOLOGI CT SCAN KEPALA
¡ CT SCAN KEPALA
¡ MRI KEPALA – DWI

11. ALBERTA STROKE PROGRAM EARLY CT SCORE (ASPECTS)

12. PEMERIKSAAN LABORATORIUM
¡ LAB RUTIN
¡ RISK FAKTORVASCULAR
¡ LAB SESUAI KEBUTUHAN KANDIDAT TROMBOLISIS

13. DDX STROKE
APAKAH INI STROKE MIMIC?

14. STROKE MIMIC
¡ BRAIN NEOPLASM
¡ MIGRAIN
¡ AVM
¡ BELL PALSY
¡ ALKOHOL
¡ GANGGUAN ELEKTROLIT
¡ HIPO/HIPERGLIKEMI
¡ DEPRESI/ANXIETY

15. KASUS
¡ Laki-laki 45 tahun, 5 jam SMRS mengeluhkan
mendadak wajah perot dan bicara pelo
disertai dengan kelemahan ½ badan bagian
kanan, OS memiliki Riwayat hipertensi
terkontrol dengan Candesartan dan Riwayat
DM dengan pengobatan metformin tidak
rutin.
¡ StrokeY/N?
¡ HemoragikY/N?

16. STROKE CHAIN OF SURVIVAL

17. Detection Recognition of Stroke Signs & Symptoms
Dispatch EMS Activation; Priority Dispatch & Response
Delivery Prompt Triage,Transport, Prehospital Notification
Door Immediate Emergency Department triage to high-acuity area
Data Prompt Emergency Department Evaluation, Stroke Team Activation, Lab
Studies and Brain Imaging
Decision Diagnosis and determination of most appropriate therapy,, Discussion with
Patient and Family
Drug Administration of appropriate Drugs /Treatment / Interventions
American Stroke Association Stroke Chain of Survival, 2016
Disposition Timely Admission to Stroke Unit, ICU, or Transfer
The 8 D’s of Stroke EMERGENCY Care

18. PRINSIP DASAR MANAJEMEN KOMPREHENSIF STROKE
1. Basic life support (SupportVital Functions)
2. Cegah Progresivitas Penyakit (Restore Cerebral Circulation,
Reduce Neurological Deficits, Prevent Progression and cell death)
3. Kendalikan faktor risiko
4. Cegah komplikasi
5. Rehabilitasi medik dan cegah stroke ulang
(Restore Patient to Optimal Level of Pre-Stroke Function)
Fase Prehospital
Fase Hiperakut
AKTIVASI CODE STROKE ?
Fase Akut
Fase rehabilitatif

19. SUSPECTED STROKE ALGORITHM
IDENTIFIKASI TANDA DAN GEJALA STROKE
AKTIVASI CODE STROKE
ASSEMEN KEGAWATDARURATAN GENERAL DAN
STABILISASI
- SUPPORT ABC, BERIKAN O2 BILA DIBUTUHKAN
- VITAL SIGN
- HITUNG ONSET SERANGAN
- AKSES IV DAN PEMERIKSAAN LABORATORIUM
- CEK GLUKOSA DARAH DAN BERIKANTERAPI BILA
DIBUTUHKAN
- PEMERIKSAAN NEUROLOGIS
- AKTIVASI STROKE TEAM
- LAKUKAN IMAGING CT/MRI BRAIN
- EKG
10
ASSEMEN OLEH STROKE TEAM
- REVIEW RIWAYAT PASIEN
- KAJI ULANG ONSET SERANGAN
- HITUNG SKOR NIHSS
25

20. SUSPECTED STROKE ALGORITHM
HASIL CT SCAN KEPALA
NON HEMORAGIK
PERTIMBANGKAN FIBRINOLITIK
- CEKLIST KRITERIA EKSKLUSI
- ASSES ULANG KONDISI PASIEN APAKAH ADA
PERBAIKAN?
45
PASIEN KANDIDAT FIBRINOLITIK
60
HEMORAGIK
- KONSULTASI BEDAH SARAF
PASIEN BUKAN KANDIDAT FIBRINOLITIK
- EDUKASI KELUARGA
- BERIKAN RTPA
- TIDAK DIBERIKAN ANTIKOAGULAN/ANTIPLATELET
DLM 24 JAM PASKA RTPA
- BERIKAN ASA
- - RAWAT DI STROKE UNIT/RUANG INTENSIF

21. KRITERIA EKSKLUSI RTPA
¡ Terdapat riwayat kelainan pembekuan darah (hemofili, ITP, gangguan factor
pembekuan darah)
¡ Pasien dalam pengobatan antikoagulan oral seperti walfarin dengan INR>1,7
¡ Menderita atau mengalami perdarahan hebat dalam 21 hari terakhir
¡ Diketahui riwayat atau suspek perdarahan intrakranial
¡ Klinis SAH atau dalam kondisi setelah SAH akibat aneurisma
¡ Riw kerusakan SSP (neoplasma, aneurisma, pembedahan intrakranial atau spinal)
¡ Sebelumnya (kurang dari 10 hari) dilakukan kompresi jantung eksternal traumatic,
persalinan, pungsi vena yang non compressible (subklavia/jugular)

22. KRITERIA EKSKLUSI RTPA
¡ Hipertensi tidak terkontrol (SBP >185 atau DBP >110)
¡ Riwayat gastrointestinal ulserative dalam 3 bulan terakhir, varises esofagus, aneurisma
arteri, malformasi arteri/vena
¡ Neoplasma dengan risiko perdarahan tinggi
¡ Gangguan hati berat, termasuk gagal hati, sirosis, hipertensi porta (varises esofagus)
dan hepatitif aktif
¡ Pembedahan mayor atau trauma yang signifikan dalam 3 bulan terakhir

23. KRITERIA EKSKLUSI RTPA
¡ Gejala serangan iskemik muncul >4,5 jam sebelum trombolisis atau onset yang tidak
diketahui
¡ Defisit Neurologis minor (NIHSS < 4), NIHSS > 21
¡ Keadaan umum bertambah buruk sebelum trombolisis diberikan
¡ Gejala sugestif menunjukkan SAH walaupun CT scan normal
¡ Pemberian Heparin dalam 48 jam terakhir dengan APTT melebihi nilai normal pada hasil lab
¡ Hitung trombosit < 100.000
¡ Glukosa darah > 400 mg/dl dan tidak dapat diturunkan dengan insulin sampai batas golden
time terlewati
¡ Anak anak usia kurang dari 18 tahun

24. ADDITIONAL ECASS III EXCLUSION CRITERIA FOR 3- TO 4.5-HOUR
WINDOW
¡ Age greater than 80
¡ NIHSS greater than 25
¡ CT early infarct signs less than one third of the MCA territory

25. KONTROL TEKANAN DARAH
¡ BILA SBP >185 MMHG ATAU DBP >110 MMHG DALAM 2 ATAU LEBIH
PENGUKURAN DENGAN SELANG 5MENIT à NICARDIPIN IV 5 -15MG/JAM
¡ LAKUKAN TITRASI NAIK TIAP 10 MENIT SAMPAI TARGET TEKANAN DARAH
TERCAPAI (MAP<130)

26. KONTROL GULA DARAH
¡ GDS > 400MG/DL TURUNKAN SESUAI ALGORITMA 1

27. DOSIS RTPA (ALTEPLASE)
Dosis Alteplase 0,6 - 0,9 mg/kgBB
DOSIS TROMBOLISIS rt-PA (alteplase) i.v.
kg
Berat pasien
Berat badan
(kg)
Dosis rt-PA total
(mg)
Dosis bolus i.v.
(10% dari total) mL
Infus i.v. 90% dari
dosis total (mL/hr)
40 36 4 32
42 38 4 34
44 40 4 36
46 41 4 37
48 43 4 39
50 45 5 40
52 47 5 42
54 49 5 44
56 50 5 45
58 52 5 47
Dosis harus disesuaikan dengan berat pasien. 10% diberikan secara bolus, diikuti dengan 90% dari total dosis selama satu jam.
Dosis total: Berat pasien (kg)
Dosis bolus = 10% dari total dosis =
Dosis infus kontinu = 90% dari total dosis =
mg i.v.
mg i.v. selama 1 menit
mg i.v. selama 1 jam
x 0,9 =
70 63 6 57
72 65 6 59
74 67 7 60
76 68 7 61
78 70 7 63
80 72 7 65
82 74 7 67
84 76 8 68
86 77 8 69
88 79 8 71
90 81 8 73
92 83 8 75
94 85 8 77
96 86 9 77
98 88 9 79
>100 90 9 81
>100 kg, gunakan maksimal 90 mg
X 0,6

28. KOMPLIKASI TROMBILISIS
¡ PERDARAHAN
¡ ALERGI ALTEPLASE
¡ SYOK ANAFILAKTIK

29. RISIKO TROMBOLISIS
STOP TROMBOLISIS BILA:
¡ Sakit kepala hebat
¡ Penurunan tingkat kesadaran
¡ Perdarahan hebat
¡ Kesulitan bernapas

30. TIME BARRIER PENANGANAN STROKE INFARK AKUT DI IGD
TIME BARRIER ACTION TO MINIMIZED
Onset gejala saat bangun tidur Tunda RTPA,WAKE UP STROKE, tidak dapat menilai
golden time trombolisis
Menunggu INR Pasien tanpa Riwayat terapi walfarin/NOAC tidak perlu
menunggu INR sebagai kandidat trombolisis à Segera
RTPA
Menunggu APTT Pasien tanpa Riwayat terapi heparin à Segera RTPA
Menunggu Elektrolit Tidak menjadi kontraindikasi absolut maupun relative
pada pemberian Alteplase à Segera RTPA
Menunggu Ur, Cre Tidak menjadi kontraindikasi absolut maupun relative
pada pemberian Alteplase à Segera RTPA

31. STABILISASI KASUS ICH DI IGD
¡ Stabilisasi tekanan darah
¡ SBP 150-220mmHg à diberikan terapi
antihipertensi dengan target SBP 130-
150mmHg
Greenberg et al 2022 Guideline for the Management of Spontaneous ICH
2b B-R
3. In patients with spontaneous ICH of mild
to moderate severity presenting with SBP
between 150 and 220 mmHg, acute lower-
ing of SBP to a target of 140 mmHg with
the goal of maintaining in the range of 130 to
150 mmHg is safe and may be reasonable for
improving functional outcomes.138,141–147
2b C-LD
4. In patients with spontaneous ICH presenting
with large or severe ICH or those requir-
ing surgical decompression, the safety and
efficacy of intensive BP lowering are not well
established.148
3: Harm B-R
5. In patients with spontaneous ICH of mild to
moderate severity presenting with SBP >150
mmHg, acute lowering of SBP to <130
mmHg is potentially harmful.146,149,150
BP-lowering agents during the hyperacute phase
after ICH, including bolus versus drip manage-
ment. Intravenous nicardipine was the drug used in
ATACH-2, whereas a range of intravenous and oral
BP-lowering agents were used in INTERACT2. Any
antihypertensive drug with rapid onset and short
duration of action to facilitate easy titration and
sustained BP control to minimize SBP variability
seems appropriate, although venous vasodilators
may be harmful because of unopposed venodila-
tion and its effect on hemostasis and ICP.157
2. The mean time from ICH onset to initiation of
EIBPL treatment in ATACH-2 was 182±57 min-
utes compared with a median of 4 hours (inter-
quartile range, 2.9–5.1 hours) in INTERACT2.141,146
Evidence suggests that any potential benefit of
Recommendations for Acute BP Lowering (Continued)
COR LOE Recommendations
Greenberg et al, 2022

32. STABILISASI KASUS ICH DI IGD
¡ Monitoring kadar gula darah
¡ Koreksi Hipoglikemi (<40-60mg/dl)
menurunkan mortalitas
¡ Koreksi Hiperglikemi (>180-200mg/dl)
meningkatkan outcome
aff
to
or
te
o-
re
ng
ew
re
ng
nd
ke
ed
nd
dy
th
es,
re
ed
ed
he
o-
type of preventive measures may reduce ND in the
acute phase of ICH.
• Caring for severely affected patients with ICH is
challenging. The potential distress of perceived
inappropriate care in nurses is an important topic
for future research.
5.3.5. Glucose Management
Recommendations for Glucose Management
Referenced studies that support recommendations are summarized in
Data Supplements 43 and 44.
COR LOE Recommendations
1 C-LD
1. In patients with spontaneous ICH, monitoring
serum glucose is recommended to reduce the
risk of hyperglycemia and hypoglycemia.256,299
1 C-LD
2. In patients with spontaneous ICH, treating
hypoglycemia (<40–60 mg/d, <2.2–3.3
mmol/L) is recommended to reduce mortal-
ity.299–301
2a C-LD
3. In patients with spontaneous ICH, treating
moderate to severe hyperglycemia (>180–
200 mg/dL, >10.0–11.1 mmol/L) is reason-
able to improve outcomes.78,302–307
Synopsis
Glucose monitoring and management are often consid-

33. STABILISASI KASUS ICH DI IGD
¡ ICH pada pasien dengan antiplatelet à operatif
¡ Pertimbangkan pemberian transfuse platelet utk
mengurangi mortality dan perdarahan paska operatif
• The potential synergistic benefits of a bundle of
care, including BP lowering and reversal of antico-
agulation, should be studied, as well as specific care
pathways (eg, keeping reversal agents on the ward,
not requiring consultation with hematology, train-
ing of nurses). Such pathways may reduce time to
reversal of anticoagulants and improve outcome.
5.2.2. Antiplatelet-Related Hemorrhage
Recommendations for Antiplatelet-Related Hemorrhage
Referenced studies that support recommendations are summarized in
Data Supplements 20 through 25.
COR LOE Recommendations
2b C-LD
1. For patients with spontaneous ICH being
treated with aspirin and who require emer-
gency neurosurgery, platelet transfusion might
be considered to reduce postoperative bleed-
ing and mortality.206
2b C-LD
2. For patients with spontaneous ICH being
treated with antiplatelet agents, the effective-
ness of desmopressin with or without platelet
transfusions to reduce the expansion of the
hematoma is uncertain.207–209
3: Harm B-R
3. For patients with spontaneous ICH being
treated with aspirin and not scheduled for
emergency surgery, platelet transfusions are
potentially harmful and should not be adminis-
tered.210
Synopsis
and requiring emergency craniotomy for removal
of the hematoma who were also receiving aspirin
therapy. Results showed that transfusion of 1 U
of previously frozen apheresis platelets before
surgery, with or without an additional platelet
unit 24 hours later, reduced postoperative rate
and volume of hemorrhage.206
Platelet transfu-
sion also was associated with higher activities
of daily living (ADL) score and lower 6-month
mortality. All patients screened were investigated
with a platelet aggregation test to exclude those
with aspirin resistance. The excluded patients did
not receive platelet transfusions; however, their
outcomes were similar to those of patients with
sensitivity to aspirin and treated with platelet
transfusions. Among the methodological limita-
tions of this trial, SAEs were not reported in this
population, cases with incomplete hemostasis
during operation were excluded, nonuniform sur-
gical procedures were performed, and the meth-
odology of ICH volume determination was below
the current standard. Platelet aggregation testing
is rarely available on an emergency basis in clini-
cal practice.
2. In 2 retrospective studies in patients with sponta-
neous ICH while taking antiplatelet agents,207,209
treatment with desmopressin (0.3 µg/kg) was
Greenberg et al, 2022

34. STABILISASI KASUS ICH DI IGD
¡ Pasien dengan ICH dan EEG epileptic
harus diberikan antiepileptic untuk
menurunkan morbiditas
¡ Pasien dengan ICH dan klinis seizure
harus diberikan antiepileptic
¡ Pasien ICH dgn abnormal (fluktuasi)
kesadaran dan dan dicurigai suatu
bangkitan harus dikerjakan EEG
¡ Tidak direkomendasikan profilaksis
antiepilptik
2022 Guideline for the Management of Spontaneous ICH
ove-
cept
eline
pec-
tem-
ated
ome
eter-
ature
ever
and
ction
rmia
ong-
evi-
eutic
es or
rma-
ated
to
5.4. Seizures and Antiseizure Drugs
Recommendations for Seizures and Antiseizure Drugs
Referenced studies that support recommendations are summarized in
Data Supplements 47 and 48.
COR LOE Recommendations
1 C-LD
1. In patients with spontaneous ICH, impaired
consciousness, and confirmed electrographic
seizures, antiseizure drugs should be adminis-
tered to reduce morbidity.325,326
1 C-EO
2. In patients with spontaneous ICH and clinical
seizures, antiseizure drugs are recommended
to improve functional outcomes and prevent
brain injury from prolonged recurrent seizures.
2a C-LD
3. In patients with spontaneous ICH and unex-
plained abnormal or fluctuating mental status
or suspicion of seizures, continuous electro-
encephalography ( 24 hours) is reasonable to
diagnose electrographic seizures and epilepti-
form discharges.327
3: No
Benefit
B-NR
4. In patients with spontaneous ICH without
evidence of seizures, prophylactic antiseizure
medication is not beneficial to improve func-
tional outcomes, long-term seizure control, or
mortality.328–331

35. STABILISASI KASUS ICH DI IGD
¡ Pasien dengan ICH / IVH dengan
penurunan kesadaran à verntrikular
drainase
¡ Efikasi dari terapi hiperosmoler untuk
peningkatan outcome masih belum pasti
¡ Terapi hiperosmoler bolus dapat diberikan
untuk mengontrol peningkatan ICP
¡ Manitol dan hipertonik salin
dipertimbangkan dengan interval 4-6 jam
7
-
e
d
-
l
r
-
c
e
-
e
e
-
d
s
-
h
n
-
e
-
d
1
c
electrographic patterns in patients with ICH and
impaired consciousness, with or without seizure,
have prognostic significance.
5.5. Neuroinvasive Monitoring, ICP, and Edema
Treatment
Recommendations for Neuroinvasive Monitoring, ICP, and Edema
Treatment
Referenced studies that support recommendations are summarized in
Data Supplements 49 through 54.
COR LOE Recommendations
1 B-NR
1. In patients with spontaneous ICH or IVH
and hydrocephalus that is contributing to
decreased level of consciousness, ventricular
drainage should be performed to reduce mor-
tality.347–350
2b B-NR
2. In patients with moderate to severe spon-
taneous ICH or IVH with a reduced level of
consciousness, ICP monitoring and treatment
might be considered to reduce mortality and
improve outcomes.159,351–356
2b B-NR
3. In patients with spontaneous ICH, the efficacy
of early prophylactic hyperosmolar therapy
for improving outcomes is not well estab-
lished.357–361
2b C-LD
4. In patients with spontaneous ICH, bolus
hyperosmolar therapy may be considered for
transiently reducing ICP.362–364
Greenberg et al, 2022

36. TERIMA KASIH ATAS PERHATIANNYA
MINUTE CAN SAVE LIVES,THE POWER OF SAVING #PRECIOUSTIME #WORLDSTROKEDAY

37. TATALAKSANA OPERATIF KASUS ICH
) in
ond
fer-
ated
hout
that
nac-
oes
ane
ated
with
her,
risk,
roid
ndi-
are
nes
GCS
<22
6. SURGICAL INTERVENTIONS
6.1. Hematoma Evacuation
6.1.1. MIS Evacuation of ICH
Recommendations for MIS Evacuation of ICH
Referenced studies that support recommendations are summarized in
Data Supplements 55 and 56.
COR LOE Recommendations
2a B-R
1. For patients with supratentorial ICH of >20- to
30-mL volume with GCS scores in the moder-
ate range (5–12), minimally invasive hematoma
evacuation with endoscopic or stereotactic
aspiration with or without thrombolytic use can
be useful to reduce mortality compared with
medical management alone.379–388
2b B-R
2. For patients with supratentorial ICH of >20-
to 30-mL volume with GCS scores in the
moderate range (5–12) being considered for
hematoma evacuation, it may be reasonable
to select minimally invasive hematoma evacu-
ation over conventional craniotomy to improve
functional outcomes.382,383,385–387,389,390
3. For patients with supratentorial ICH of >20-

38. e
at
ts
d
n
28
e
d
ic
e
e,
s,
ic
20
g
rk
d
m-
of
compare different surgical approaches for evacu-
ation of IVH. Are endoscopic techniques superior
to EVD plus IVT, and is addition of lumbar drainage
superior to EVD alone plus IVT for outcomes or
avoidance of permanent shunting?
6.1.3. Craniotomy for Supratentorial Hemorrhage
Recommendations for Craniotomy for Supratentorial Hemorrhage
Referenced studies that support recommendations are summarized in
Data Supplements 63 and 64.
COR LOE Recommendations
2b A
1. For most patients with spontaneous supra-
tentorial ICH of moderate or greater severity,
the usefulness of craniotomy for hemorrhage
evacuation to improve functional outcomes or
mortality is uncertain.380,382,384,393,429–431
2b C-LD
2. In patients with supratentorial ICH who are
deteriorating, craniotomy for hematoma evacu-
ation might be considered as a lifesaving
measure.382,384,429,432
Synopsis
For most patients, craniotomy for spontaneous ICH