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The purpose of monitoring patients with acute stroke is to detect secondary injury and intervene to reverse or halt this process. While intracerebral hemorrhage (ICH) remains without a treatment of proven benefit from a phase III randomized trial, considerable observational evidence suggests that good neurocritical care makes a difference.1,2 However, the optimal method of monitoring remains unclear. In this issue of Neurology®, Maas et al.3 analyzed whether care was influenced by a standardized clinical and radiologic surveillance protocol administered to all ICH patients. This involved hourly neurologic examination in a neurosciences critical care unit as well as serial noncontrast CT imaging at 6, 24, and 48 hours after the initial diagnostic CT scan. They found that in about 10% of patients, a subsequent neurosurgical intervention was performed based on new information obtained as part of this surveillance strategy. Furthermore, while about half of these interventions were prompted by clinical examination changes, half were based on neuroimaging findings prior to any clinical examination change.
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the editorial.
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- © 2013 American Academy of Neurology
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