Management of acute intracerebral haemorrhage - an update

Abstract

Managing acute intracerebral haemorrhage is a challenging task for physicians. Evidence shows that outcome can be improved with admission to an acute stroke unit and active care, including urgent reversal of anticoagulant effects and, potentially, intensive blood pressure reduction. Nevertheless, many management issues remain controversial, including the use of haemostatic therapy, selection of patients for neurosurgery and neurocritical care, the extent of investigations for underlying causes and the benefit versus risk of restarting antithrombotic therapy after an episode of intracerebral haemorrhage.

Keywords: Antithrombotic; blood pressure; intracerebral haemorrhage; management; neurosurgery; stroke.

Fig 1.

Haematoma expansion. A – non-contrasted CT brain showing right basal ganglia haematoma; B – CT brain 24 hours later showing haematoma expansion with peri-haematomal oedema, midline shift and intraventricular extension. Courtesy of Mark Sampson, University of Nottingham. CT = computerised tomography

Fig 2.

Cerebral amyloid angiopathy. Magnetic resonance susceptibility-weighted imaging sequence showing superficial siderosis (white arrow) and cerebral microhaemorrhage (white arrow head), which are features supportive of a diagnosis of cerebral amyloid angiopathy.