Intracerebral Hemorrhage, Primary

Primary intracerebral hemorrhage (ICH) accounts for 10% of all strokes but is the least treatable and most deadly. The most important risk factors are hypertension (which typically produces deep brain hemorrhages) and cerebral amyloid angiopathy (which produces lobar hemorrhages). Clinical presentation is indistinguishable from that of ischemic stroke with the exception that ICH is more commonly associated with signs of increased intracranial pressure. ICH is easily identified on computed tomography (CT) or magnetic resonance imaging (MRI), and MRI or angiography may identify an underlying lesion, particularly in nonhypertensive individuals with atypical bleeding locations. Treatment strategies focus on medical stabilization, prevention/limitation of secondary neurological injury, and supportive care to prevent medical complications. As with ischemic stroke, however, prevention through risk factor management remains the most effective means of reducing mortality and morbidity due to ICH.