Intracerebral%20hemorrhage Management

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 (ICH) 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 ICH
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

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