A 68-year-old man presents with sudden right hemiparesis. CT shows a left basal ganglia hemorrhage of 25 mL with no hydrocephalus and no intraventricular extension. Admission BP is 192/104 mmHg. Per current guidelines for spontaneous intracerebral hemorrhage, the systolic BP should be targeted to approximately:
- A 180 mmHg
- B 160 mmHg
- C 140 mmHg ✓
- D 115 mmHg
Correct answer: C. 140 mmHg
Explanation
For spontaneous intracerebral hemorrhage presenting with systolic BP between 150 and 220 mmHg without contraindications, guidelines support acute lowering toward 140 mmHg, which limits hematoma expansion without increasing cerebral ischemia risk. Rapid reduction below about 130 mmHg is avoided. A target of 180 mmHg reflects outdated practice, while 115 mmHg risks hypoperfusion at the hemorrhage margin. This differs from ischemic stroke, where higher pressures are tolerated.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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