Skip to main content
SpringerLink
Log in

Intracerebral Hemorrhage

  • Chapter
Neurointensive Care

  • 1655 Accesses

Abstract

Intracerebral hemorrhage (ICH) is one of the most devastating forms of stroke and has a high mortality rate and little effective treatment. The median 1 month case fatality is 40–50 % and only 12–39 % of patients achieve functional independence. In patients with acute ICH, large hematoma volume, the presence of intraventricular hemorrhage (IVH), and prior use of anticoagulation or antiplatelet are reported to be associated with poor outcome. Early intensive lowering of blood pressure (BP), a systolic BP level of less than 140 mmHg, as compared with the conservative level of BP currently recommended in guidelines, did not result in a significant reduction in the rate of death or major disability. However, there were significantly better functional outcomes among patients with intensive lowering of BP. For most patients with ICH, even though superficial lobar ICH of less than 100 mL, neurosurgical intervention was not significant. Mortality rates for patients with ICH with an associated IVH range from 50 to 80 %. The preliminary results in the study for treatment with intraventricular tissue plasminogen activator have shown benefit.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Anderson RN, Smith BL. Deaths: leading causes for 2002. Natl Vital Stat Rep. 2005;53:1–89.

    PubMed  Google Scholar 

  2. Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF. Spontaneous intracerebral hemorrhage. N Engl J Med. 2001;344:1450–60.

    Article  CAS  PubMed  Google Scholar 

  3. Dennis MS, Burn JP, Sandercock PA, Bamford JM, Wade DT, Warlow CP. Long-term survival after first-ever stroke: the Oxfordshire Community Stroke Project. Stroke. 1993;24:796–800.

    Article  CAS  PubMed  Google Scholar 

  4. Gebel JM, Broderick JP. Intracerebral hemorrhage. Neurol Clin. 2000;18:419–38.

    Article  CAS  PubMed  Google Scholar 

  5. Ariesen MJ, Claus SP, Rinkel GJ, Algra A. Risk factors for intracerebral hemorrhage in the general population: a systematic review. Stroke. 2003;34:2060–5.

    Article  CAS  PubMed  Google Scholar 

  6. Hemphill JC, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001;32:891–7.

    Article  PubMed  Google Scholar 

  7. Brott T, Broderick J, Kothari R, et al. Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke. 1997;28:1–5.

    Article  CAS  PubMed  Google Scholar 

  8. Delgado Almandoz JE, Yoo AJ, Stone MJ, et al. The spot sign score in primary intracerebral hemorrhage identifies patients at highest risk of in-hospital mortality and poor outcome among survivors. Stroke. 2010;41:54–60.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Morgenstern LB, Hemphill 3rd JC, Anderson C, Becker K, Broderick JP, Connolly Jr ES, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2010;41(9):2108–29.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Rose JC, Mayer SA. Optimizing blood pressure in neurological emergencies. Neurocrit Care. 2004;1:287–99.

    Article  PubMed  Google Scholar 

  11. Powers WJ, Asams RF, Yundt KD. Acute pharmacological hypotension after intracerebral hemorrhage does not change cerebral blood flow. Stroke. 1999;30:242.

    Google Scholar 

  12. Vemmos KN, Tsivgoulis G, Spengos K, Zakopoulos N, Synetos A, Manios E, Konstantopoulou P, Mavrikakis M. U-shaped relationship between mortality and admission blood pressure in patients with acute stroke. J Intern Med. 2004;255:257–65.

    Article  CAS  PubMed  Google Scholar 

  13. Kazui S, Minematsu K, Yamamoto H, Sawada T, Yamaguchi T. Predisposing factors to enlargement of spontaneous intracerebral hematoma. Stroke. 1997;28:2370–5.

    Article  CAS  PubMed  Google Scholar 

  14. Anderson CS, Huang Y, Arima H, et al. Effects of early intensive blood pressure lowering treatment on the growth of hematoma and perihematomal edema in acute intracerebral hemorrhage: the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT). Stroke. 2010;41:307–12.

    Article  PubMed  Google Scholar 

  15. Anderson CS, Heeley E, Huang Y, Wang J, Stapf C, Delcourt C, et al. INTERACT2 Investigators. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013;368:2355–65.

    Google Scholar 

  16. Steiner T, Al-Shahi Salman R, Beer R, Christensen H, Cordonnier C, Csiba L, Forsting M, Harnof S, Klijn CJ, Krieger D, Mendelow AD, Molina C, Montaner J, Overgaard K, Petersson J, Roine RO, Schmutzhard E, Schwerdtfeger K, Stapf C, Tatlisumak T, Thomas BM, Toni D, Unterberg A, Wagner M. European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage. Int J Stroke. 2014;9(7):840–55.

    Article  PubMed  Google Scholar 

  17. Hallevi H, Albright K, Aronowski J, et al. Intraventricular hemorrhage: anatomic relationships and clinical implications. Neurology. 2008;70:848–52.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Young WB, Lee KP, Pessin MS, et al. Prognostic significance of ventricular blood in supratentorial hemorrhage: a volumetric study. Neurology. 1990;40:616–9.

    Article  CAS  PubMed  Google Scholar 

  19. Steiner T, Diringer MN, Schneider D, et al. Dynamics of intraventricular hemorrhage in patients with spontaneous intracerebral hemorrhage: risk factors, clinical impact, and effect of hemostatic therapy with recombinant activated factor VII. Neurosurgery. 2006;59:767–73.

    Article  PubMed  Google Scholar 

  20. Tuhrim S, Horowitz DR, Sacher M, et al. Volume of ventricular blood is an important determinant of outcome in supratentorial intracerebral hemorrhage. Crit Care Med. 1999;27:617–21.

    Article  CAS  PubMed  Google Scholar 

  21. Mayer SA, Thomas CE, Diamond BE. Asymmetry of intracranial hemodynamics as an indicator of mass effect in acute intracerebral hemorrhage. A transcranial Doppler study. Stroke. 1996;27:1788–92.

    Article  CAS  PubMed  Google Scholar 

  22. Mayfrank L, Kissler J, Raoofi R, et al. Ventricular dilatation in experimental intraventricular hemorrhage in pigs characterization of cerebrospinal fluid dynamics and the effects of fibrinolytic treatment. Stroke. 1997;28:141–8.

    Article  CAS  PubMed  Google Scholar 

  23. Wasserman JK, Zhu X, Schlichter LC. Evolution of the inflammatory response in the brain following intracerebral hemorrhage and effects of delayed minocycline treatment. Brain Res. 2007;1180:140–54.

    Article  CAS  PubMed  Google Scholar 

  24. Naff N, Williams MA, Keyl PM, et al. Low-dose recombinant tissue-type plasminogen activator enhances clot resolution in brain hemorrhage: the intraventricular hemorrhage thrombolysis trial. Stroke. 2011;42:3009–16.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Xi G, Keep RF, Hoff JT. Mechanisms of brain injury after intracerebral haemorrhage. Lancet Neurol. 2006;5:53–63.

    Article  PubMed  Google Scholar 

  26. Keep RF, Xi G, Hua Y, Hoff JT. The deleterious or beneficial effects of different agents in intracerebral hemorrhage: think big, think small, or is hematoma size important? Stroke. 2005;36:1594–6.

    Article  PubMed  Google Scholar 

  27. Bhattathiri PS, Gregson B, Prasad KS, Mendelow AD, STICH Investigators. Intraventricular hemorrhage and hydrocephalus after spontaneous intracerebral hemorrhage: results from the STICH trial. Acta Neurochir Suppl. 2006;96:65–8.

    Article  CAS  PubMed  Google Scholar 

  28. Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM, STICH II Investigators. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet. 2013;382:397–408.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea

    Moon Ku Han MD, PhD

Authors
  1. Moon Ku Han MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Moon Ku Han MD, PhD .

Editor information

Editors and Affiliations

  1. Neurological Intensive Care Unit, Martin Luther University Halle-Wittenberg, Halle (Saale), Sachsen-Anhalt, Germany

    Katja E. Wartenberg

  2. Department of Critical Care, Medinah National Hospital, Medinah Munnawarah, Saudi Arabia

    Khalid Shukri

  3. Department of Neurology, Southern Illinois University School of Medicine, Springfield, Illinois, USA

    Tamer Abdelhak

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Han, M.K. (2015). Intracerebral Hemorrhage. In: Wartenberg, K., Shukri, K., Abdelhak, T. (eds) Neurointensive Care. Springer, Cham. https://doi.org/10.1007/978-3-319-17293-4_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-17293-4_9

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-17292-7

  • Online ISBN: 978-3-319-17293-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation