Good Treatment of Hyperacute Intracerebral Hemorrhage Is as Easy as ABC

Abstract

Nontraumatic intracerebral hemorrhage is a devastating disease with a high mortality and significant morbidity in survivors. 1 Differentiating ischemic stroke from intracerebral hemorrhage in the prehospital setting and without brain imaging is not possible. Therefore, most patients with nontraumatic intracerebral hemorrhage are admitted under a "code stroke" pathway to the closest hospital with the capacity to provide basic diagnosis and care for ischemic stroke (i.e., brain imaging and intravenous thrombolysis), so called primary stroke centers (PSCs) or tele stroke centers (TSCs), hospitals with an emergency department linked through telephone to a specialized center. Comprehensive stroke centers (CSCs) are larger hospitals with the capacity to provide endovascular stroke treatment, neurosurgery, and often specialized neuro-intensive care units. Patients with ischemic stroke with specific needs are usually transferred from a PSC/TSC to a CSC for specialized interventions (i.e., endovascular stroke treatment or decompressive surgery) if they are not directly admitted to a CSC because this was the nearest center.