The latest therapeutic advances with spontaneous intracerebral hemorrhage

Abstract

Introduction: Intracerebral hemorrhage (ICH) accounts for 10% of strokes; however, compared with ischemic stroke, progress leading to novel treatments and improved patient outcomes has been lacking. Recently, there have been several promising developments and renewed research interest within the field. Positive results from randomized controlled trials have now been reported in multiple domains of care for patients with ICH. Anticoagulation-associated ICH is increasingly frequent, and clinicians deciding on reversal and timing of re-initiation of oral anticoagulation now have more therapeutic agents available and evidence to guide them. Minimally invasive techniques are also added to the neurosurgical arsenal, leading to improvements in functional outcomes. Acute treatment at presentation is best served by bundled care approaches, which ensure goal-directed management of blood pressure, glucose and temperature.

Areas covered: This narrative review summarizes the recent developments in this area, as well as the current recommendations of key international guidelines. Literature search was carried out using PubMed database with priority given to publications since 2020.

Expert opinion: There is renewed optimism for innovation in ICH. The standard of care for this condition now leads to improvements in mortality and long-term functional ability. Efforts to improve the patient selection and surgical techniques for operative management are ongoing.

Keywords: Intracerebral hemorrhage; anticoagulation; minimally invasive surgery; reversal; stroke.