Impact of Recent Studies for the Treatment of Intracerebral Hemorrhage

  • Jochen A. Sembill
  • Hagen B. Huttner
  • Joji B. KuramatsuEmail author
Stroke (H Diener, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Stroke


Purpose of Review

The present review will cover most recent and important studies on acute treatment of intracerebral hemorrhage (ICH).

Recent Findings

Overly pessimistic prognostication in ICH may deny meaningful recovery achieved by specialized neurocritical care. Hematoma enlargement represents the most important target of acute ICH care, which is reduced by aggressive blood pressure management (targeting a systolic blood pressure of 140 mmHg) and appropriate hemostatic treatment especially in anticoagulation-associated ICH (INR reversal using prothrombin complex concentrates, eventually idarucizumab, andexanet, or tranexamic acid). Surgical treatment strategies involving fibrinolytics either used for direct hematoma lysis or used for intraventricular clot removal with/without additional lumbar drainage show great promise. Further novel treatment strategies are underway and need validation or evaluation strongly warranting well-designed future ICH research.


Several randomized and large-sized observational studies have considerably expanded the field and the evidence on how to treat acute ICH patients. Yet, the one breakthrough intervention to improve functional outcome is still missing, though various treatment concepts possibly interacting with one another have been evaluated and such treatment bundle may improve patients’ outcome.


Intracerebral hemorrhage Neurocritical care Hemorrhagic stroke 



Blood pressure


Confidence interval


Do not resuscitate


External ventricular drain


Fresh frozen plasma


Hematoma enlargement


Intracerebral hemorrhage


Intracranial pressure


International normalized ratio


Interquartile range


Intraventricular hemorrhage


Modified Rankin Scale


Non-vitamin k antagonist oral anticoagulant


Odds ratio


Prothrombin complex concentrate


Risk ratio


Recombinant tissue-type plasminogen activator


Tranexamic acid


Vitamin K antagonist


Compliance with Ethical Standards

Conflict of Interest

Jochen A. Sembill, Hagen B. Huttner, and Joji B. Kuramatsu declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Jochen A. Sembill
    • 1
  • Hagen B. Huttner
    • 1
  • Joji B. Kuramatsu
    • 1
    Email author
  1. 1.Department of NeurologyUniversity Hospital Erlangen-NürnbergErlangenGermany

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