Prehospital and Emergency Department Management of Intracerebral Hemorrhage

  • Muhammad Fawad Ishfaq
  • Nitin Goyal
  • Abhi Pandhi
  • Marc MalkoffEmail author


Intracerebral hemorrhage (ICH) is the second most common subtype of stroke and a critical disease usually leading to severe disability or death. Around 20% of patients with ICH will experience a decrease in the Glasgow Coma Scale of two or more points between the prehospital assessment and the initial evaluation in the emergency department (ED). Therefore, aggressive prehospital and ED treatment is cornerstone for effective management of patients with ICH. Initial management should focus on urgent stabilization of cardiorespiratory variables and treatment of intracranial complications. Recent technological innovations have opened new perspectives for stroke diagnosis and treatment before the patient arrives at the hospital. These prehospital measures include presumed stroke diagnosis by paramedics, mobile telemedicine for remote clinical examination and imaging, mobile stroke units with integrated computerized tomography (CT) scanners, point-of-care laboratories in ambulances, and prehospital notification provided by emergency medical staff (EMS). Primary management of ICH in ED includes rapid clinical evaluation, laboratory studies including blood glucose and coagulation defects, diagnostic imaging studies, management of blood pressure and early intracranial complications such as hydrocephalus or impending herniation, and admission to stroke unit or neuroscience intensive care unit (NICU). In this book chapter, we will discuss in detail about various prehospital and ED management strategies for management of patients with ICH.


Intracerebral hemorrhage Intraventricular hemorrhage Ventriculostomy Mobile stroke unit Chronic hypertension Untreated hypertension Antiplatelet Hematoma Anticoagulation Antihypertensive Hematoma growth Stroke outcomes Computed tomography Computed tomography angiography 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Muhammad Fawad Ishfaq
    • 1
  • Nitin Goyal
    • 1
  • Abhi Pandhi
    • 1
  • Marc Malkoff
    • 1
    Email author
  1. 1.Department of NeurologyUniversity of Tennessee Health Science CenterMemphisUSA

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