Update on intracerebral hemorrhage

Compared to ischemic stroke, intracerebral hemorrhage (ICH) has higher mortality and worse morbidity. Unfortunately, we still lack a primary treatment for ICH. Promising trials using recombinant activated factor VII (rFVIIa) to prevent hematoma expansion have not yielded consistent improvement in outcome, and a large multicenter surgical trial failed to show benefit. Thus, management focuses on supportive care, including management of blood pressure, intraventricular hemorrhage, glucose, and fever. This chapter summarizes the trials of rFVIIa and surgery and provides an update on the issues surrounding the management of hypertension, intraventricular hemorrhage, glucose, and fever. Recent work on the impact of antiplatelet agents and statins on the incidence and severity of ICH is reviewed, and some new considerations regarding defining prognosis and limiting care are discussed.