Management of Intracranial Hemorrhage

  • Ariel P. SantosEmail author


Patients presenting with the cardinal signs and symptoms of intracranial hemorrhage require rapid assessment and treatment. In addition to the primary and secondary surveys, timely neuroradiologic imaging and swift admission to the stroke and neuroscience ICU is imperative. Computed tomography (CT) scan is considered to be the gold standard and helps to determine the intracranial hemorrhage (ICH) score, a measure of severity. Once ICH is confirmed, appropriate treatment should be initiated as soon as possible based on the etiology and severity of the intracranial hemorrhage.


Intracranial hemorrhage Intracranial bleed ICH ICH score 


  1. 1.
    Hemphill JC III, Greenberg SM, Anderson CS, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46:2032–60.CrossRefGoogle Scholar
  2. 2.
    Hemphill JC III, Bonovich DC, Besmertis L, et al. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001;32:891–7.CrossRefGoogle Scholar
  3. 3.
    Rincon F, Mayer SA, Rivolta J, et al. Impact of delayed transfer of critically ill stroke patients from the emergency department to the Neuro-ICU. Neurocrit Care. 2010;13:75–81.CrossRefGoogle Scholar
  4. 4.
    Elmer J, Pallin DJ, Liu S, et al. Prolonged emergency department length of stay is not associated with worse outcomes in patients with intracerebral hemorrhage. Neurocrit Care. 2012;17:334–42.CrossRefGoogle Scholar
  5. 5.
    Sakamoto Y, Koga M, Todo K, et al. Relative systolic blood pressure reduction and clinical outcomes in hyperacute intracerebral hemorrhage: the SAMURAI-ICH observational study. J Hypertens. 2015;33(5):1069–73.CrossRefGoogle Scholar
  6. 6.
    Anderson CS, Heeley E, Huang Y, et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013;368:2355–65.CrossRefGoogle Scholar
  7. 7.
    Dennis M, Sandercock P, Reid J, et al. CLOTS Trial Collaboration. Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicenter randomized controlled trial. Lancet. 2013;382:516–24.Google Scholar
  8. 8.
    Paciaroni M, Agnelli G, Venti M, et al. Efficacy and safety of anticoagulants in the prevention of venous thromboembolism in patients with acute cerebral hemorrhage: a meta-analysis of controlled studies. J Thromb Haemost. 2011;9:893–8.CrossRefGoogle Scholar
  9. 9.
    Kelly J, Hunt BJ, Lewis RR, Rudd A. Anticoagulation or inferior vena cava filter placement for patient with primary intracerebral hemorrhage developing venous thromboembolism? Stroke. 2003;34:2999–3005.CrossRefGoogle Scholar
  10. 10.
    Beghi E, D’Alessandro R, Beretta S, et al. Incidence and predictors of acute symptomatic seizure after stroke. Neurology. 2011;77:1785–93.CrossRefGoogle Scholar
  11. 11.
    Kollmar R, Juettler E, Huttner HB, et al. Cooling in intracerebral hemorrhage (CINCH) trial: protocol of a randomized German-Austrian clinical trial. Int J Stroke. 2012;7:168–73.CrossRefGoogle Scholar
  12. 12.
    Hutchinson PJ, Kolias AG, Timofeev EA, et al. Trial of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med. 2016;375(12):1119–30.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of SurgeryTexas Tech University Health Sciences CenterLubbockUSA

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