Critical Care Medicine-Neurologic Disorders>>>>>Cerebrovascular Diseases
Question 6#

A 73-year-old woman, with prior parietal intraparenchymal hemorrhage approximately 6 months prior and ischemic stroke approximately 2 years prior, presents to the emergency department after being found slumped in a chair at home and unresponsive. She was intubated for airway protection, and a head CT demonstrated a large left frontal intracerebral hemorrhage with intraventricular extension and SAH as well as 5 mm of left-to-right midline shift. Her pertinent medications at home are metoprolol 25 mg daily and aspirin 81 mg daily. Her vital signs in the emergency department are heart rate (HR) 86, blood pressure (BP) 124/68, and SpO2 98% on 40% FiO2 . Her basic metabolic panel and complete blood count are normal. Her only medication at the time of evaluation is propofol for sedation.

What medications/treatments should be added to the patient’s current regimen? 

A. Platelet transfusion
B. Platelet transfusion and levetiracetam
C. Platelet transfusion, levetiracetam, and labetalol infusion
D. Levetiracetam and labetalol infusion
E. No additional medications are needed

Correct Answer is E


Correct Answer: E

There are no additional medications that are needed at this time. Given her intracerebral hemorrhage, she should have aggressive BP management to maintain a systolic BP goal of <140 for at least the first 24 hours. The patient’s BP is currently below the goal target of 140 mm Hg, so no additional intervention is needed. Intracerebral hemorrhage can result in early clinical seizure, but these early seizures do not change clinical outcomes and the use of prophylactic antiepileptics is not recommended as they might worsen patient’s outcome. Lastly, the use of antiplatelet agents before an intracerebral hemorrhage can be a confounding factor. Based on the results of the PATCH study, platelet transfusions are not recommended for use in the setting of intracerebral hemorrhage while taking antiplatelet medication as they appear to increase risk of death or dependence. 


  1. Anderson CS, Heeley E, Huang Y, et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013;368:2355-2365.
  2. Beg E, D’Alessandro R, Beretta S, et al. Incidence and predictors of acute symptomatic seizures after stroke. Neurology. 2011;77:1785-1793.
  3. Hemphill JC, Greenberg SM, Anderson CS, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46:1-29.