Tratamento das hemorragias intracranianas espontâneas: o dilema continua

Resumo

Introdução As doenças cerebrovasculares (DCV) são a principal causa de morte no Brasil, sendo um grande problema de saúde pública em todo o mundo.

Métodos Revisão da literatura utilizando o banco de dados do MEDLINE. Buscados os termos “intracerebral” e “hemorrhage” presentes no título e no resumo publicados em qualquer data.

Resultados As hemorragias intracranianas (HIC) acometem, principalmente, os lobos cerebrais, gânglios da base, tálamo, tronco cerebral (predominantemente a ponte) e cerebelo como resultado da ruptura de vasos cerebrais afetados pelos efeitos degenerativos da hipertensão arterial sistêmica (HAS) ou da angiopatia amiloide. O diagnóstico pode ser feito através da tomografia computadorizada de crânio (TCC), sendo auxiliado pela ressonância nuclear magnética (RNM) do encéfalo e a angiografia dos quatro vasos cerebrais na investigação etiológica. Tratamento: dividido em clínico e cirúrgico. Atualmente, não há consenso sobre a seleção do tipo de tratamento para pacientes com HIC, e esta decisão deve levar em consideração idade do paciente, estado neurológico, tamanho e profundidade do hematoma, presença de hidrocefalia e de efeito compressivo. Os estudos atuais mostram uma tendência de superioridade dos procedimentos cirúrgicos minimamente invasivos, com menor risco de lesão encefálica secundária decorrente do acesso cirúrgico ao hematoma.

Conclusão A escolha da melhor estratégia para o tratamento das HIC permanece um desafio e ainda deve ser feita de forma individualizada.

Abstract

Introduction Cerebrovascular Diseases are the major cause of death in Brazil and a public health issue in the world.

Methods Review of the literature using the MEDLINE's data bank. We have searched the keywords “intracerebral” and “hemorrhages” in the title and abstract.

Results Intracranial hemorrhages (ICH) affect, mainly, the cerebral lobes, basal ganglia, thalamus, brain stem and the cerebellum as a result of the rupture of diseased cerebral vessels by the effects of hypertension or amyloid angiopathy. Diagnosis can be done with the use of a non-contrast computed tomography (CT), magnetic resonance imaging (MRI) and cerebral angiogram (useful in investigation of the etiology). Treatment can be divided in clinical and surgical. This decision still should be taken considering individual features, such as patient's age and neurological status, hematoma's size and deep, time between ictus and the procedure, presence of hydrocephalus and compressive effects. The studies has shown a preference for the minimally invasive procedures, since the secondary brain lesions caused by the surgery tend to be less.

Conclusion The choice of what would be the best strategy to treat the ICH is still a challenge and this decision should be taken individually.

Palavras-Chave

hemorragia - intracerebral - intracraniana - espontânea

Keywords

intracranial hemorrhages - stroke - brain injuries - neurosurgical procedures

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