Treatment Guideline Chart
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 (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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