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Infarctus cérébraux sus-tentoriels graves : prise en charge en réanimation

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Accident vasculaire cérébral et réanimation

Part of the book series: Le point sur… ((POINT))

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Résumé

Aujourd’hui, seule une faible proportion des infarctus cérébraux (IC) est admise en réanimation. Le vieillissement de la population et la prise en charge de plus en plus agressive des patients les plus graves devraient conduire à une augmentation de l’admission de ces patients en réanimation. La prise en charge neurochirurgicale de l’accident vasculaire cérébral (AVC) ischémique malin, dont l’efficacité a été démontrée, comprend non seulement le geste chirurgical (craniectomie décompressive), mais aussi des mesures de réanimation comme la ventilation invasive périopératoire et l’optimisation des agressions cérébrales secondaires. La décision d’une gestion thérapeutique intensive doit se fonder sur des critères anamnestiques, cliniques et radiologiques, mais également intégrer les souhaits du patient et de sa famille, les handicaps et comorbidités antérieurs et enfin une estimation aussi objective que possible du devenir. S’il existe un ensemble de données identifiées qui permettent de juger de l’évolution, aucune ne peut servir indépendamment à la prise de décision de poursuite ou d’arrêt de la réanimation.

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  1. Pôle d’anesthésie réanimation, Centre hospitalier universitaire de Toulouse, Université Paul Sabatier, Toulouse, France

    A. Luzi & T. Geeraerts

  2. Service de neurologie, Centre hospitalier universitaire de Toulouse, Hôpital Purpan, Université Paul Sabatier, Toulouse, France

    J.-F. Albucher

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Luzi, A., Albucher, JF., Geeraerts, T. (2013). Infarctus cérébraux sus-tentoriels graves : prise en charge en réanimation. In: Accident vasculaire cérébral et réanimation. Le point sur…. Springer, Paris. https://doi.org/10.1007/978-2-287-99031-1_3

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