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Answer 6
  1. Phenytoin. Use of antiepileptic medications such as phenytoin is indicated for treatment of seizures that commonly occur after a lobar hemorrhage or brief prophylaxis in patients with lobar hemorrhage. Since this patient’s hemorrhage is not lobar, it would be more appropriate to defer treatment with antiepileptic medications unless seizure activity occurs.6 In the acute phase of treating intracerebral hemorrhage, as in this case, the goal is to prevent expansion of hematoma. Use of medications (eg, labetalol) to counteract severe hypertension as well as medications to reverse anticoagulation (eg, vitamin K, fresh frozen plasma) are all appropriate steps that may limit hematoma expansion. Hyperglycemia in the first 24 hours after intracerebral hemorrhage is associated with poor outcomes; thus, early management of hyperglycemia (ie, use of insulin) is indicated.

    6. Broderick J, Connolly S, Feldmann E, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke 2007;38: 2001–23.

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