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Semin Neurol 2015; 35(06): 638-645
DOI: 10.1055/s-0035-1564687
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Evaluation and Management of Adult Intracerebral Hemorrhage

Xuemei Cai
1   Division of Neurocritical Care and Emergency Neurology, Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Boston, Massachusetts
,
Jonathan Rosand
2   Division of Neurocritical Care and Emergency Neurology, Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts
› Author Affiliations
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Publication History

Publication Date:
23 November 2015 (online)

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Abstract

Intracerebral hemorrhage (ICH) is the most disabling and deadly form of stroke. Although mortality remains high, new data suggest that outcomes can be improved with standardized medical care. In this review, the authors outline the most up-to-date knowledge, including the results of the latest phase III clinical trials on the specialized care needed to treat patients with ICH. They provide an overview on how to achieve rapid diagnosis and the initial steps of intervention to reduce hematoma volume or prevent expansion by modifying potentially treatable conditions, such as underlying vascular etiologies, blood pressure control, and coagulopathies. Grading scales can help identify patients at risk for hematoma expansion and functional disabilities and guide clinical decision making. Other medical management topics important to recovery and prevention of secondary brain injury include seizure prevention and treatment, glycemic control, temperature control, and deep venous thrombosis prophylaxis and treatment. Treatment options in surgery are also possible in select patients; there are emerging studies regarding minimally invasive surgery for the management of ICH. These aggressive therapies are essential to lower the morbidity and mortality of patients presenting with ICH.

Keywords

intracerebral hemorrhage - diagnosis - treatment - coagulopathy - surgery
 

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