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Semin Neurol 2010; 30(5): 555-564
DOI: 10.1055/s-0030-1268865
© Thieme Medical Publishers

Spontaneous Intracerebral Hemorrhage

Maria I. Aguilar1 , W. David Freeman2
  • 1Department of Neurology, Mayo Clinic, Phoenix, Arizona
  • 2Department of Neurology, Mayo Clinic, Jacksonville, Florida
Further Information

Publication History

Publication Date:
04 January 2011 (online)

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ABSTRACT

Spontaneous intracerebral hemorrhage (sICH) is defined as bleeding within the brain parenchyma, and occurs twice as commonly as subarachnoid hemorrhage, but is equally as deadly. Risk factors for sICH include hypertension, advanced age, leukoaraiosis, prior ICH, renal failure, use of anticoagulant drugs, and cerebral amyloid angiopathy. When a patient is clinically suspected of having sICH, head computed tomography scan is the standard diagnostic tool. However, newer magnetic resonance neuroimaging techniques may aid in determining the underlying pathology and aid in prognosis. Supportive care and blood pressure management are important in the care of patients with sICH. Ongoing research is aimed at determining a safe blood pressure goal that may also prevent expansion of hemorrhage. Hemostatic medications and neuroprotectants have thus far not shown clinical improvement. Although several neurosurgical trials have failed to demonstrate benefit for surgical evacuation of sICH, multiple research trials are ongoing investigating acute blood pressure control, deep or basal ganglionic hemorrhage evacuation via minimally invasive approach (MISTIE; http://mistietrial.com/default.aspx), lobar ICH evacuation (STICH; II http://research.ncl.ac.uk/stich/), and intraventricular thrombolysis with tissue plasminogen activator (tPA) (CLEAR III; http://biosgroup-johnshopkinsmedicine.health.officelive.com/default.aspx).

KEYWORDS

Intracerebral hemorrhage - intracranial hemorrhage - brain hemorrhage

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Maria I AguilarM.D. 

Mayo Clinic Arizona, 5777 E. Mayo Blvd.

Phoenix, AZ 85054

Email: Aguilar.Maria@mayo.edu