Diagnosis and Management of Spontaneous Intracerebral Hemorrhage.

PURPOSE OF REVIEW: This article updates neurologists on recent insights and management strategies of intracerebral hemorrhage (ICH).

RECENT FINDINGS: Blood pressure reduction likely improves outcomes in patients with intracerebral hemorrhage, although not by the expected mechanism of reducing hematoma growth. One formulation of prothrombin complex concentrate for reversing severe bleeding associated with warfarin is now approved by the US Food and Drug Administration (FDA), and specific reversal therapies for the novel oral anticoagulants are in development. Neurologic monitoring frequently detects ICH worsening that requires an intervention. Platelet transfusion and pharmacologic platelet activation are promising and often used as part of patient management but have not yet been shown to improve patient outcomes.

SUMMARY: Measurable progress continues toward establishing effective therapies to improve outcomes in patients with ICH. Blood pressure reduction and reversal of medications that exacerbate bleeding are likely to improve outcomes. Recommendations for neuromonitoring will help clinicians at the bedside attend to the most important abnormalities and optimize later quality of life. This article reviews standards for diagnosis and severity of ICH, monitoring and treatment of complications in the hospital, available interventions, and the measurement of outcomes.