• HPI

    • 53-year-old
    • Acute onset obtundation, vomiting and left hemiplegia
    • Intubated in the Emergency Department
    • Diagnosis of Spontaneous ICH established
    • Vascular imaging ruled out occult vascular imaging
    • Contralateral EVD placed and MR Imaging Obtained

     

    Figure 1: Axial FLAIR and Coronal T2W MRI

    The current state of the published literature most supports which of the following treatment strategies for ICH > 1 cm from any cortical surface:

    2. Were an endoscopic approach entertained, which of the following represents the most proven trajectory for this clot distribution?

    3. Which of the following may increase the likelihood of procedural benefit?

    4. In early phases of MISTIE-ICES Trial, which of the following corresponded with improved procedural outcome?

    5. Which of the following describes you?

    6. I practice in one of the following locations.

    7. Please add any suggestions or comments regarding this case:
     
    • Excellent postoperative result.
    • thank you for the video illustration

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    Pubmed References

    • Hanley, Daniel. “MISTIE II: 365 Day Outcome and Cost Benefit.” RO1NS046309

    • Mendelow et al for STICH II Invesitgators. “Early Surgery versus Initial Conservative Treatment in patients with spontaneous supratentorial lobar intracerebral hematomas (STICH II)” Lancet 2013; 382: pp. 397-408

    • Picture of initial clot interface on peel away sheath introduction
      Illustrative videos showing clot evacuation and progressive cavity collapse

    <iframe width="560" height="315" src="https://www.youtube.com/embed/poD5WuC8KZ0" frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe>

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