The management of haemorrhagic stroke

Intracerebral haemorrhage (ICH) accounts for 8-13% of all strokes and results from a variety of disorders. ICH is more likely to result in death or major disability than ischaemic stroke or subarachnoid haemorrhage. Rapid imaging allows early diagnosis and characterization of the localization and severity of the haemorrhage. Patients with acute ICH should be managed in an intensive care unit. Treatment entails general supportive care, control of blood pressure (BP) and intracranial pressure (ICP), prevention of haematoma expansion and, where indicated, neurosurgical intervention. The 30-day mortality from intracerebral haemorrhage (ICH) ranges from 35-52%. Among survivors, the prognosis for functional recovery depends upon the location of haemorrhage, size of the haematoma, level of consciousness, patient age, and overall medical health and condition. Rupture of arterial aneurysms is the major cause of subarachnoid haemorrhage (SAH). Aneurysm rupture releases blood directly into the cerebrospinal fluid (CSF) which spreads quickly within the CSF, rapidly increasing intracranial pressure. Death or deep coma ensues if the bleeding continues. The bleeding usually lasts only a few seconds but rebleeding is common and associated with a high mortality. Surgical clipping and endovascular coiling are effective in preventing rebleeding and generally should be performed early. Clinically significant vasospasm complicates 20-30% of aneurysmal SAH and is associated with delayed cerebral ischaemia and worse neurologic outcome.