The management of spontaneous primary intracerebral haemorrhage

Intracerebral haemorrhage (ICH) accounts for around 10-20% of all strokes and results from a variety of disorders. ICH is more likely to result in death or major disability than ischaemic stroke or subarachnoid haemorrhage. Rapid imaging allows early diagnosis and characterization of the localization and severity of the haemorrhage. Patients with significant acute ICH should be managed in a critical care unit. Treatment entails general supportive care, control of blood pressure and intracranial pressure, prevention of haematoma expansion and, where indicated, neurosurgical intervention. In those patients whose bleed extends into the ventricular system or who have infratentorial bleeds are at increased risk of associated hydrocephalus, rapidly increasing intracranial pressure requiring urgent CSF drainage. The 30-day mortality from intracerebral haemorrhage ranges from 35-52%. Among survivors, the prognosis for functional recovery depends upon the location of haemorrhage, size of the haematoma, level of consciousness, the patient's age, and overall medical condition.