CURRENT CRITICAL MANAGEMENT OF CURRENT CRITICAL MANAGEMENT OF SPONTANEOUS INTRACEREBRAL SPONTANEOUS INTRACEREBRAL HAEMORRHAGEHAEMORRHAGE (SICH)(SICH)Setyo Widi NugrohoSetyo Widi NugrohoDepartment of Neurosurgery Department of NeurosurgeryPadjadjaran University/Hasan Sadikin HospitalPadjadjaran University/Hasan Sadikin Hospital Bandung Bandung IntrodutionIntrodution!Spontaneous intraere"ral hemorrhage #SI$H% isa"lood lot that arises in the "rainparenhyma inthea"seneof trauma or surgery !&his entity aounts for '( to ')* of all strokes !Higher mortality rate than either ishemi stroke or su"arahnoid hemorrhage !+""rupt elevation of "lood pressure rupture of small penetrating arteries Pathology , -oationPathology , -oation .tiology.tiology!$ommon auses /0hypertension0amyloidangiopathy0oagulopathy0vasular anomalies0tumors1 and 0various drugs Diagnosti ProedureDiagnosti Proedure!Physial diagnosti +"rupt onset of onsiousness and neurologi defiits!2adiodiagnosti / 0$& sanning /! Initial diagnosti modality of hoie in SI$H0+ngiography ! should "e onsidered in all ases e3ept those involving older patients 4ith pree3isting hypertension in thalami1 putaminal1 or ere"ellar hemorrhage 052I1 52+ $2I&I$+- 5+N+6.5.N&$2I&I$+- 5+N+6.5.N&!Initial 5anagement /0Identify site of haemorrhage 4ithin neura3is!$linial e3am!2adiodiagnosti / $& San 152I1 52+1 DS+0Prevent su"se7uent damage from re"leeding edema1 or hypo3ia8 Initial stepsInitial steps!+ir4ay, Breathing ontrol06$S 9 : Intu"ation0P$;< / luid 5anagement /! Intavenous solution # euvolume1 slight hyperosmolar%! 5anitol