Neurovascular Critical Care

Ischemic stroke and intracranial hemorrhage are among the most devastating and debilitating injuries in medicine. Initial management principles for acute ischemic stroke rely on prompt revascularization before the brain parenchymal is infarcted. Large hemispheric infarctions and malignant cerebral edema occur uncommonly in a subset of patients with acute ischemic stroke and are associated with high morbidity and mortality rates. The indications for decompressive hemicraniectomy for malignant cerebral edema are reviewed. Medical management of intraparenchymal hematomas and aneurysmal subarachnoid hemorrhage in the intensive care setting is emphasized. Important clinical sequelae of subarachnoid hemorrhage such as rebleeding, cerebral vasospasm, and cerebral salt wasting are reviewed.   This review contains 5 figures, 4 tables and 52 references Key Words:  acute ischemic stroke, cerebral aneurysm, cerebral vasospasm, decompressive hemicraniectomy, intracerebral hemorrhage, large hemispheric infarctions, subarachnoid hemorrhage, malignant cerebral edema