CVA-04 · Intracerebral Hemorrhage

Intracerebral Hemorrhage. Part of the Cerebrovascular / Stroke series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: We do not intervene to lower it unless it crosses a massive threshold of 220 over 120. — Correct: 220/120 is the ceiling only if alteplase was NOT given. After alteplase, blood pressure must be kept below 185/110 pre-infusion and below 180/105 for 24 hours after. (2) In the audio: The lack of response to naloxone is your true discriminator. — Correct: Naloxone nonresponse does not distinguish a pontine hemorrhage from opioid toxicity and is not a diagnostic test. A comatose patient can have both, and a single low dose can fail in genuine opioid toxicity, so nonresponse to one dose excludes nothing; repeat dosing may be needed. Give naloxone for its therapeutic effect, support airway and ventilation, and let urgent CT with the neurological examination and the wider context establish the diagnosis. (3) In the audio: Going from a score of two to a score of three takes a patient from a 26% mortality rate up to a 72% mortality rate. That is the prognostic cliff that matters when you are speaking with families about expectations. — Correct: Those numbers are the 30-day mortality observed at each score in the original 152-patient ICH Score derivation cohort, not a cliff a patient falls off by gaining one point. The steepness between 2 and 3 reflects how the component points distributed in that small cohort, and the observed mortality is partly self-fulfilling, because early do-not-resuscitate orders and withdrawal of support tracked the same scores. No patient in that cohort scored 6. Use the score to frame a conversation about expectations, never to justify limiting care: current guidance is to give aggressive care and defer new DNAR or withdrawal decisions until at least the second full hospital day when no prior limitation is documented. This correction is filed from the chapter's attributed quote block and the banked ruling; the live recording was not re-transcribed and no audio cutover was performed. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/CVA-04.