Vitor Sossai Bozzi
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Débora Cavalini Gabriel
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Francisco Mateus Vieira
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Mateus Alan Marasca
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Priscila Martins Langbecker
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Context: Hemorrhagic stroke (HS) is characterized by cerebral vessel´s rupture, causing potentially fatal hemorrhage. Approximately 20% of HS are due to spontaneous intracranial hemorrhage, being risk factors: age over 55, systemic arterial hypertension, smoking, obesity, physical inactivity and alcoholism. Case Report: Male, 84 years old, previously hypertensive, is brought by family members after being found unconscious. He was admitted to hypertensive emergency room, with irregular respiratory rate, anisochoric pupils (mydriasis on the right) non-photoreactive, Glasgow Coma Scale 3 and urinary loss. He was intubated without complications and later developed bradycardia (44 bpm), keeping hypertensive (160/90 mmHg), suggesting Cushing´s Triad (CT). Capillary bloody glucose of 98 mg/dl and laboratory tests showing: hemoglobin 9,3; platelets 184000; negative troponin; urea 52; creatinine 1.7; sodium 136; potassium 3.9. Due to the abrupt installation in a previously hypertensive patient, with unilateral mydriasis on physical examination and the development of CT, the diagnostic hypothesis were HS associated with intracranial hypertension. A skull´s scancomputed tomography or lumbar puncture were not requested because were unavailable at hospital. Patient was removed to a specialized servisse, 12 hours after arrival. Conclusion: Mortality after stroke is known to be substantially lower when patients are treated in high-volume regional centers and have access to qualified interventionists who specialize in neuro-intensive treatment. As it is a servisse without resources for definitive treatment, the patient was stabilized in the best way within the hospital condition, with priority being the removal of the patient as soon as possible, in order to reduce morbidity and mortality