Management of Intracerebral Hemorrhage: JACC Focus Seminar

J Am Coll Cardiol. 2020 Apr 21;75(15):1819-1831. doi: 10.1016/j.jacc.2019.10.066.

Abstract

Intracerebral hemorrhage (ICH) accounts for a disproportionate amount of stroke-related morbidity and mortality. Although chronic hypertension and cerebral amyloid angiopathy are the underlying cerebral vasculopathies accounting for the majority of ICH, there are a broad range of potential causes, and effective management requires accurate identification and treatment of the underlying mechanism of hemorrhage. Magnetic resonance imaging and vascular imaging techniques play a critical role in identifying disease mechanisms. Modern treatment of ICH focuses on rapid stabilization, often requiring urgent treatment of mass effect, aggressive blood pressure reduction and correction of contributing coagulopathies to achieve hemostasis. We discuss management of patients with ICH who continue to require long-term anticoagulation, the interaction of ICH with neurodegenerative diseases, and our approach to prognostication after ICH. We close this review with a discussion of novel medical and surgical approaches to ICH treatment that are being tested in clinical trials.

Keywords: anticoagulation; cavernous malformation; cerebral amyloid angiopathy; endocarditis; melanoma; prognosis; secondary intracerebral hemorrhage.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Anticoagulants / adverse effects
  • Antihypertensive Agents / therapeutic use
  • Brain Neoplasms / complications
  • Cerebral Amyloid Angiopathy / complications
  • Cerebral Hemorrhage / diagnosis
  • Cerebral Hemorrhage / etiology
  • Cerebral Hemorrhage / therapy*
  • Coagulants / therapeutic use
  • Diagnosis, Differential
  • Drainage
  • Humans
  • Hypertension / complications
  • Intracranial Arteriovenous Malformations / complications
  • Prognosis

Substances

  • Anticoagulants
  • Antihypertensive Agents
  • Coagulants