Management of Intracranial Hemorrhage

Intracerebral hemorrhage (ICH) accounts for approximately 10% of all strokes. Its clinical importance however derives from the high mortality, which varies from 25% to 60%. After decades of neglect, the last 3 years have been particularly eventful for clinical research on spontaneous ICH, with completion of a large randomized trial of surgical clot evacuation as well as a medical trial to stop parenchymal bleeding and prevent clinical worsening by using recombinant factor VII. The greatest strides in reducing disability from hemorrhagic strokes may come from their prevention. ICH can be prevented by adequate treatment of hypertension and angiotensin-receptor blockers, angiotensin converting enzymes inhibitors and calcium channel blockers seem to be particularly effective. Newer innovations in diagnosing and managing vascular malformation have also contributed significantly to prevention of ICH. Prevention of ICH due to cerebral amyloid angiopathy has entered the treatment era by a phase II study on cerebril, a drug that may help to prevent amyloid deposition.