Specific treatment of intracerebral hemorrhage

Spontaneous, nontraumatic intracerebral hemorrhage (ICH) is the most serious and least treatable form of stroke, affecting several million people in the world each year, most of whom reside in low-to-middle income countries where hypertension and other cardiovascular risk factors are highly prevalent. ICH arises in brain parenchyma, and often extends into the ventricular system and subarachnoid, subdural, or extradural spaces, to cause varying degrees of mass effect, hydrocephalus, seizures, and other complications of brain injury and associated disability. Limited progress in the prevention and management of this complex illness is reflected in stable incidence and case fatality of ICH in many populations over recent decades. Moreover, persistence of a nihilist approach to patient care, most apparent in the early application of withdrawal-of-care (palliative) orders and restricted use of angiography to exclude an underlying structural cause, is common in many health systems. The management of patients with ICH is largely supportive, with the aim of reducing the degree of brain injury and preventing complications. Advances in medical management, such as intensive blood pressure lowering and hemostatic treatment and focused surgery show considerable promise for improving patient outcomes.