Translational Stroke Research

, Volume 3, Supplement 1, pp 10–24

Intracerebral Hemorrhage: Clinical Overview and Pathophysiologic Concepts

Review Article

DOI: 10.1007/s12975-012-0175-8

Cite this article as:
Rincon, F. & Mayer, S.A. Transl. Stroke Res. (2012) 3: 10. doi:10.1007/s12975-012-0175-8
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Abstract

Intracerebral hemorrhage is by far the most destructive form of stroke. Apart from the management in a specialized stroke or neurological intensive care unit (NICU), no specific therapies have been shown to consistently improve outcomes after ICH. Current guidelines endorse early aggressive optimization of physiologic derangements with ventilatory support when indicated, blood pressure control, reversal of any preexisting coagulopathy, intracranial pressure monitoring for certain cases, osmotherapy, temperature modulation, seizure prophylaxis, treatment of hyerglycemia, and nutritional support in the stroke unit or NICU. Ventriculostomy is the cornerstone of therapy for control of intracranial pressure patients with intraventricular hemorrhage. Surgical hematoma evacuation does not improve outcome for more patients, but is a reasonable option for patients with early worsening due to mass effect due to large cerebellar or lobar hemorrhages. Promising experimental treatments currently include ultra-early hemostatic therapy, intraventricular clot lysis with thrombolytics, pioglitazone, temperature modulation, and deferoxamine to reduce iron-mediated perihematomal inflammation and tissue injury.

Keywords

StrokeHypertensionCerebral edemaIntracranial pressureNeurological intensive careIntensive careNeurocritical care

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Neurology and Neurosurgery, Division of Critical Care and NeurotraumaThomas Jefferson UniversityPhiladelphiaUSA
  2. 2.Department of Neurology and Neurosurgery, Division of Stroke and Critical Care, College of Physicians and SurgeonsColumbia UniversityNew YorkUSA
  3. 3.Neurological Intensive Care UnitMilstein Hospital BuildingNew YorkUSA