Hypertensive intracerebral hemorrhage

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By Adrian Marchidann MD

Dr. Adrian Marchidann of SUNY Downstate Medical Center provides an update on the progress in imaging modalities utilized in patients with intracerebral hemorrhage. New prognosis scores are introduced and the impact of an early do-not-resuscitate order is discussed. In addition, the latest clinical trials on blood and intracranial pressure management are reviewed.

Key points

  • A pathogenetic classification system was proposed—SMASH-U, which is helpful in determination of prognosis and risk of recurrence.
  • Enlarged perivascular spaces are an imagistic marker of risk for hypertensive and cerebral amyloid angiopathy.
  • Surgical decompression does not improve the outcome in patients with elevated ICP.
  • It is unclear what is the optimal blood pressure and how fast it should be reached.
  • There are several surgical modalities to reduce the volume of hematoma and surrounding edema with or without the aid of tPA, many of which are in the experimental stage only.
  • Early surgery may improve the outcome of patients with Glasgow Coma Scale (GCS) 9 to 12, hematoma volume of 20 to 50 ml, and perhaps those with superficial hematomas without intraventricular blood.
  • Patients in a coma are likely to be hurt by surgical management.
  • Transfer of patients to a specialized center with neurosurgical services is likely to improve their outcome, whether or not they have surgery.

In This Article

Historical note and nomenclature
Clinical manifestations
Pathogenesis and pathophysiology
Differential diagnosis
Diagnostic workup
Prognosis and complications
References cited