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Intracerebral Hemorrhage

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Emergency Neurology

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Abstract

Intracerebral hemorrhage (ICH) accounts for 10–15% of all strokes, but results in disproportionately high morbidity and mortality. Although chronic hypertension accounts for the majority of ICH, other common causes include cerebral amyloid angiopathy, sympathomimetic drugs of abuse, and underlying arteriovenous malformations. Validated baseline predictors of clinical outcome after ICH include the 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 minimally invasive surgical and medical treatments for ICH. Research has suggested that perihematoma injury and secondary neurologic injury are more likely related to toxicity of blood and iron in the brain rather than primary ischemic injury. Novel oral anticoagulants and new-generation antiplatelet agents have also posed new challenges in the management of spontaneous ICH. 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 the utility of reversal agents for novel oral anticoagulants and the efficacy of minimally invasive surgical evacuation.

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  1. Department of Neurosurgery, Semmes-Murphey Clinic and University of Tennessee Health and Science Center, Memphis, TN, USA

    David Dornbos III & Kendrick Johnson

  2. Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA, USA

    Pratik V. Patel

  3. Department of Neurology and Neurosurgery, Semmes-Murphey Clinic, University of Tennessee Health Sciences Center, Memphis, TN, USA

    Lucas Elijovich

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    Karen L. Roos

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Dornbos, D., Johnson, K., Patel, P.V., Elijovich, L. (2021). Intracerebral Hemorrhage. In: Roos, K.L. (eds) Emergency Neurology. Springer, Cham. https://doi.org/10.1007/978-3-030-75778-6_9

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