Intracerebral Hemorrhage

Intracerebral hemorrhage remains one of the most deadly and disabling forms of neurologic disease. The evaluation and management are focused on rapid stabilization and diagnostic testing to rule out the presence of an underlying lesion such as an aneurysm, vascular malformation, or tumor that would require additional testing or treatment in the acute phase. Treatment strategies are limited to control of blood pressure, reversal of anticoagulation, control of intracranial pressure, and supportive care. Surgery is often reserved for the emergent management of increased intracranial pressure or mass effect from the hematoma. Minimally invasive intracerebral hemorrhage evacuation has demonstrated benefit in some settings and is under active investigation in multiple clinical trials. Prognosis overall is poor and is negatively impacted by advanced age, larger hematoma, hematoma located in subcortical locations, the presence of intraventricular hemorrhage, and poor neurologic examination at presentation. Fortunately, significant scientific and translational efforts are underway to develop novel pharmaceutical, device, and data-driven innovations which are likely to lead to novel treatments for this devastating disease process in the near future.