Intracerebral hemorrhage is the sudden burst of blood into the brain tissue itself.
It causes sudden onset of focal neurological deficit.
The focal neurologic findings are related to the anatomic location, size and speed of development of intracerebral hemorrhage.
Neurological deficit usually progresses over a minute to an hour.
Rapid recognition and diagnosis of intracerebral hemorrhage are essential because of its frequently rapid progression.

Intracerebral%20hemorrhage Management

Secondary Prevention

  • Hypertension 
    • Target BP <140/90 mmHg or <130/80 mmHg for those with diabetes or chronic kidney disease
    • BP control with antihypertensives particularly for those whose bleed was in a typical location of hypertensive vasculopathy 
  • Patient should be advised to stop smoking, heavy alcohol intake and use of illicit drugs 
  • Recommendations are still unclear regarding continuing or discontinuing statin therapy in patients with ICH
    • There are conflicting reports on the effect of statin in patients with ICH
  • Although physical exertion, sexual activity or stress has not been linked to ICH, there is little systematic data that have been reported

Risk Factors for Recurrence

  • Uncontrolled hypertension
  • Initial intracerebral hemorrhage location
    • Lobar is the most common in amyloid angiopathy
    • Location of hypertensive vasculopathy (eg basal ganglia, thalamus and brainstem)
  • Old age
  • Post-ICH anticoagulation
    • Associated with increased risk of recurrence
    • Avoidance of long-term anticoagulation as treatment for nonvascular atrial fibrillation (AF) after spontaneous lobar intracerebral hemorrhage
    • Antiplatelet treatment may be a safer option to anticoagulation after all types of intracerebral hemorrhage
  • Presence of apolipoprotein E ε2 or ε4 alleles
  • Presence of greater number of microbleeds on magnetic resonance imaging (MRI) scan
  • History of ischemic stroke

Predictors of Poor Outcome 

  • Old age and overall health condition
  • Intraventricular hemorrhage
  • Deep or infratentorial ICH
  • Increasing ICH volume
  • Decreasing Glasgow Coma Scale score
  • Preceding antithrombotic therapy
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Cardiology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Elvira Manzano, 13 Apr 2020
A gout drug that’s been around for years reduced the risk of ischaemic cardiovascular (CV) events when given at a low dose in patients who had myocardial infarction (MI) and was cost-effective, an analysis of the COLCOT* trial has shown.
Pearl Toh, 23 Apr 2020
Taking ticagrelor alone — and dropping aspirin — after 3 months of DAPT* post-PCI** significantly reduced bleeding events without increasing the risk of ischaemic adverse events compared with continuing a DAPT of ticagrelor plus aspirin, the TICO*** trial has shown.
Roshini Claire Anthony, 17 Jul 2020

Icosapent ethyl may reduce the risk of cardiovascular (CV) events in patients with diabetes mellitus (DM) taking statins, according to findings of REDUCE-IT DIABETES presented at ADA 2020.

Elaine Soliven, 12 Apr 2019
The use of catheter ablation as first-line treatment reduces the number of premature ventricular complexes (PVCs) in a paediatric population, according to a study presented at EHRA 2019.