Pharmacist’s Guide to Common Intracranial Bleeding Terms and Treatments

Objective: Pharmacists care for patients with intracranial bleeding such as those with subarachnoid hemorrhage (SAH) or subdural hematoma (SDH), although these bleeding events are often generically termed “head bleed.” This over-simplified term refers to a heterogeneous group of life-threatening intracranial hemorrhages, each with a distinctive etiology and treatment paradigm. Data sources: Common intracranial hemorrhage types were reviewed to identify the scope of this narrative review. Study selection and data abstraction: Relevant studies and guidelines pertinent to the selected topic were considered. Data synthesis: Various hemorrhage types such as intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and SDH fall into the colloquialism of “head bleed.” However, these and other hemorrhage types are radiographically distinct and often require different management strategies. Surgical management is helpful in some of these situations (SDH, SAH) and limited in scope for others (ICH). Pharmacotherapy for reversal of coagulopathy and treatment of elevated intracranial pressure may be considered similar across the spectrum of intracranial bleeding pathologies, while other factors such as seizure prophylaxis and blood pressure control depend on the bleeding type. Relevance to patient care and clinical practice: Differences in the need for surgical intervention, neurologic monitoring, cerebral perfusion changes, risk of seizure, optimal blood pressure, and other clinical characteristics make each type of intracranial bleeding unique. Conclusions: Pharmacists should be aware of the differences in surgical and pharmacotherapy strategies among these intracranial hemorrhages to optimize care for this neurocritical care population.