Guidelines for the Management of Spontaneous Intracerebral Hemorrhage in Adults

Abstract

Purpose-The aim of this statement is to present current and comprehensive recommendations for the diagnosis and treatment of acute spontaneous intracerebral hemorrhage. Methods-A formal literature search of Medline was performed through the end date of August 2006. The results of this search were complemented by additional articles on related issues known to the writing committee. Data were synthesized with the use of evidence tables. The American Heart Association Stroke Council's Levels of Evidence grading algorithm was used to grade each recommendation. Prerelease review of the draft guideline was performed by 5 expert peer reviewers and by the members of the Stroke Council Leadership Committee. It is intended that this guideline be fully updated in 3 years' time. Results-Evidence-based guidelines are presented for the diagnosis of intracerebral hemorrhage, the management of increased arterial blood pressure and intracranial pressure, the treatment of medical complications of intracerebral hemorrhage, and the prevention of recurrent intracerebral hemorrhage. Recent trials of recombinant factor VII to slow initial bleeding are discussed. Recommendations for various surgical approaches for treatment of spontaneous intracerebral hemorrhage are presented. Finally, withdrawal-of-care and end-of-life issues in patients with intracerebral hemorrhage are examined.

Experimental Intracerebral Hemorrhage: Avoiding Pitfalls in Translational Research

“…This is an important question clinically, as the presence of perihematomal ischemia would favor a role for surgery and argue against blood pressure lowering to prevent hematoma expansion on the grounds that this may exacerbate perihematomal hypoperfusion (Broderick et al, 2007). Animal studies initially suggested the existence of an ischemic penumbra evidenced by decreased perihematomal blood flow (Bullock et al, 1988;Mendelow et al, 1984).…”

Nationwide survey of antihypertensive treatment for acute intracerebral hemorrhage in Japan

“…American Heart Association/American Stroke Association (AHA/ASA) guidelines 17 and the Japanese Guidelines for the Management of Stroke 2004 18 both recommend lowering of BP for ICH patients with systolic blood pressure (SBP) of 4180 mm Hg or mean arterial pressure of 4130 mm Hg. The target BP level has not been defined.…”

Early mortality in spontaneous supratentorial intracerebral haemorrhage

“…Despite the data available from well designed studies, especially from the Surgical Trial in Intracerebral Haemorrhage (STICH), there is incertitude about which is the proper treatment in a particular patient with spontaneous supratentorial intracerebral haemorrhage 3,6,8,15,16,17,18,19,21,22 . The variability among patients, as well as the great number of factors that influence their outcome, are important issues to take into account.…”

“…It is estimated that this condition affects 10-20 in 100 000 people every year with a mortality between 23-58% 1,13,20,21 . Additionally, only one of five of the survivors regain functional independence at 6 months after ictus 3,13,14,15,20 . There is no definitive evidence to guide treatment but recommendations 15,16,20 .…”