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Emergency Management of Acute Intracerebral Hemorrhage

  • Andrea Morotti
  • Joshua N. GoldsteinEmail author
Chapter
  • 59 Downloads
Part of the Current Clinical Neurology book series (CCNEU)

Abstract

Intracerebral hemorrhage (ICH) accounts for up to 20% of acute cerebrovascular events and is the stroke type with the worst prognosis. Hematoma expansion is common after ICH and represents an appealing target for acute treatment; however, ICH still lacks a clinically proven anti-expansion therapy. The majority of ICH patients have high blood pressure in the acute phase. Intensive blood pressure reduction to systolic 140 mm Hg (but not below) appears safe and may improve outcome. Premorbid anticoagulant use increases the odds of hematoma expansion and death, and emergent coagulopathy reversal is typically used. The role of surgery in acute ICH remains controversial, and there is strong evidence in favor of decompressive surgery and hematoma evacuation only for cerebellar ICH with clinical deterioration and/or radiological evidence of brainstem compression. Infections, seizures, and deep venous thromboses are the main medical complications of ICH. Admission to a neurointensive care unit is associated with more favorable functional outcome.

Keywords

Intracerebral hemorrhage Blood pressure Anticoagulation Hematoma expansion Surgery 

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Stroke Unit, Department of Neurology and NeurorehabilitationIRCCS Mondino FoundationPaviaItaly
  2. 2.J. P. Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical SchoolBostonUSA
  3. 3.Department of Emergency MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonUSA

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