Section 5 - Management and critical care

Summary

This chapter discusses the basic principles of management of intracerebral hemorrhage (ICH), including initial stabilization, the prevention of hematoma growth, and hemodynamic goal-setting. It also talks about the treatment of potential complications such as cerebral edema, herniation and seizures, and identification of the underlying etiology. The occurrence of ICH is strongly related to premorbid blood pressure; however, the relationship between the growth of hematoma and uncontrolled blood pressure remains to be clarified. The medical management of acute ICH revolves around the concept of hematoma stabilization. Recently published research may help identify patients that are at greater risk of hematoma expansion by the presence of tiny enhancing foci following CT angiography. Amyloid angiopathy is a common etiological factor in older patients, especially those older than 65 years who have multiple lobar hemorrhages. In hemorrhages in patients who are on anticoagulation, a risk-benefit ratio needs to be established before restarting anticoagulation.