Treatment

Patients are managed in neurological intensive care units. Control of the blood pressure is of primary importance particularly in the hypertensive patient. Correction of any coagulation disturbance also takes priority. Medical maneuvers to decrease intracranial pressure are performed with caution because hematoma size can actually increase if decompressed as tamponade is diminished. Patients with supratentorial hemorrhages and hydrocephalus are treated with external ventricular drains. Ventricular drains are used with reluctance in cerebellar hemorrhages for fear of causing upward herniation and death. Surgical evacuation is reserved for patients who present in relatively good neurological condition but deteriorate despite medical management, and only if the surgical approach does not require traversing eloquent brain. Hematomas commonly reaccumulate postoperatively and a high index of suspicion is used in these postevacuation patients who subsequently deteriorate. Stereotactic aspiration is another treatment option. This approach benefits from a lower morbidity, but the ability to effectively drain the hematoma has not been clearly established.

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Breaking Bulimia

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