Intracerebral Hemorrhage in Renal Compromised State: How is the Combination?

• DOI: 10.4103/aian.aian_612_23
• Publication Date: 2023-09-11T17:01:07Z
• Authors: Debabrata Chakrab...
• Keywords: Pathophysiology; Stroke

Intracerebral hemorrhage (ICH) in a renal compromised state is unique situation where the pathophysiology of ailment, clinical scenario, management, and outcome differs from other situations. These patients have high morbidity mortality. In with very low eGFR ICH, one-month mortality rate was found to be 5.5 fold one-year 7.5 times more than normal function ICH.[1] They usually higher stroke score (NIHSS score) showing that impaired could associated severity.[1] Those moderate-to-severe impairment 2.3 hematoma volume (compared those without dysfunction) at lobar location.[2] fact, severity function, intracerebral volume, uncontrolled blood pressure, initial neurological status are significant prognostic factors these groups patients.[3] There always an increased risk bleeding failure, because following reasons: Changes platelets due change α-granules, dysregulation prostaglandin, arachidonic metabolism calcium mobilization. Increased activation fibrinolytic system oxidative stress. Activation within dialysis filter (dialysis-related thrombocytopenia). Reduced GP Ib receptor for adhesion molecules on endothelial cells, vasoactive substances (Nitric Oxide), reduced binding vWF IIb/IIIa complex, finally anemia causing platelet-vessel wall interaction. Accumulation anti-thrombotics (especially anticoagulants) decreased clearance. Management ICH challenge! As discussed, there chance expansion. The use anti-edema measures address peri-lesional edema not straightforward. possibility may worsen current also cause further disruption electrolyte acid-base balance. Hemodialysis cerebral setting ICH.[4] It advisable delay hemodialysis until subsides considerable extent, especially who getting newly introduced replacement therapy.[4] We need ensure gradual removal urea, continuous hemofiltration better this setting. treating team needs monitor parameter closely, manage intravenous fluids, carefully avoid drugs function. Interestingly, intensive pressure lowering harmful ICH.[5] So, should brought down gradually fluctuations avoided maintain steady perfusion group patients. Most elderly, co-morbidities like diabetes, past vascular events, critically ill. Patients glomerular filtration stress, anemia, calcium-phosphate derangement, hypercoagulability, lipoprotein level, immunity. they infection, cardiovascular cerebrovascular event any point time.[1] If technically workable, evacuated earliest possibility. Advanced techniques minimally invasive endoscopic evacuation utilized this. Such procedure prevent expansion hematoma, mitigate secondary injury, minimize intraoperative post-operative re-bleeding. This will decrease raised intracranial quickly and, if successfully carried out, life-threatening complications. by doing this, stormy period its perilesional management can minimized. More studies probably required handle such condition. team, patient, family understand type easy-going process patient catastrophic even all best efforts. study has beautifully showed difference between suffered acute ICH.[6]