ICU · Neurocritical care

Acute stroke: ischaemic, haemorrhagic, and SAH — comprehensive ICU management

Also known as Acute stroke · Ischaemic stroke · Intracerebral haemorrhage · ICH · Subarachnoid haemorrhage · Thrombolysis · Thrombectomy

Acute stroke = sudden neurological deficit from cerebral vascular event. THREE TYPES: (1) ISCHAEMIC (about 85% — arterial occlusion — thrombus/embolus). (2) INTRACEREBRAL HAEMORRHAGE [ICH] (10-15% — intraparenchymal bleed — hypertension/amyloid). (3) SUBARACHNOID HAEMORRHAGE [SAH] (5-7% — aneurysmal rupture). ISCHAEMIC: THROMBOLYSIS (alteplase within 4.5h — NINDS/ECASS III) + THROMBECTOMY (DAWN/DEFUSE-3 — for large vessel occlusion [LVO] within 6-24h with salvageable penumbra). ICH: BP control (SBP <140 — INTERACT2/ATACH-2), ICH score for prognosis, surgical evacuation (CEREBELLAR — life-saving; SUPRATENTORIAL — STICH II — no routine benefit). SAH: nimodipine (reduces vasospasm + improves outcomes — 60 mg PO q4h x 21 days), BP control (SBP <160 pre-aneurysm securing), vasospasm management (induced hypertension — but NOT triple-H — avoid hypervolaemia). ICU: BP (permissive hypertension for ischaemic [SBP <185 for thrombolysis, <140 for ICH]), temperature (normothermia — fever worsens outcomes), glucose (avoid hypo- and marked hyperglycaemia), swallowing assessment (before oral intake), DVT prophylaxis (LMWH). MORTALITY: ischaemic 10-15%; ICH 35-50%; SAH 30-40%.

Checked against its sources on 11 Sept 2026