Intracerebral hemorrhage

Abstract

Intracerebral hemorrhage (ICH) accounts for 10–15% of all strokes but results in a disproportionately high morbidity and mortality. While chronic hypertension accounts for the majority of ICH, other common causes include cerebral amyloid angiopathy, sympathomimetic drugs of abuse, and underlying cerebral vascular anomalies. Validated baseline predictors of clinical outcome after ICH include the initial Glasgow Coma Scale score, hematoma volume, presence and amount of intraventricular hemorrhage, infratentorial ICH location, and advanced age. Although no treatment of proven benefit currently exists for ICH, several recent large clinical trials have demonstrated the feasibility of investigation of surgical and medical treatments for ICH. Clinical research into ICH mechanisms of injury has demonstrated that hematoma expansion is common, even in patients without coagulopathy. Basic research has suggested that perihematomal injury is more likely related to toxicity of blood and iron in the brain (“neurohemoinfl ammation”) rather than primary ischemic injury. Current guidelines for ICH treatment emphasize blood pressure management, urgent and rapid correction of coagulopathy, and surgery for cerebellar ICH. Ongoing clinical trials are investigating surgical evacuation of lobar hemorrhage, minimally invasive surgical hematoma evacuation, and aggressive blood pressure lowering.