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  • Review Article
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Advances in the management of intracerebral hemorrhage

Nature Reviews Neurology volume 6, pages 593–601 (2010)Cite this article

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Abstract

Intracerebral hemorrhage (ICH) is a major public-health problem worldwide. No proven treatments are available for this condition, which is associated with high rates of morbidity and mortality. Only 20% of individuals who survive ICH are independent at 6 months. Hypertension, cerebral amyloid angiopathy (CAA) and anticoagulation are known to be associated with such hemorrhages. No effective preventive therapies exist specifically for CAA-related ICH. The incidence of hypertension-related ICH might be decreasing in some populations with improvements in the treatment of hypertension; however, the incidence of anticoagulant-related ICH is increasing, as the use of anticoagulants rises. Many questions remain unanswered regarding the clinical management of ICH, although in the past 10 years completed medical and surgical clinical trials—examining hemostatic therapy, blood pressure control and/or hematoma evacuation—have refined our understanding of the goals of such management. Ongoing clinical trials, which have built on the lessons of past studies, hold promise for the development of effective, scientifically proven treatments for ICH. In this Review, we discuss clinical trials for ICH that have been completed in the past 10 years, the contributions of these studies to the clinical management of ICH, and the ongoing trials that might further improve clinical care.

Key Points

  • Globally, ≈2 million people every year develop intracerebral hemorrhage (ICH), which is associated with high morbidity and mortality rates and has no effective treatment

  • Medical trials conducted for acute ICH in the past decade have included trials of hemostasis with recombinant factor VIIa and trials of blood pressure control

  • Surgical trials for ICH of the past 10 years have included studies of craniotomy with clot evacuation, and minimally invasive clot aspiration with or without thrombolysis

  • Data generated from medical and surgical trials have led to improvements in our understanding of the strategies to undertake for effective clinical management of ICH

  • Ongoing trials show promise for the development of a therapy that improves ICH outcomes

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Figure 1: Hematoma expansion revealed by CT.

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Acknowledgements

Laurie Barclay, freelance writer and reviewer, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. Department of Emergency Medicine, Division of Neurocritical Care, University of Cincinnati Medical Center, 231 Albert Sabin Way, ML 0769, Cincinnati, 45267-0525, OH, USA

    Opeolu Adeoye

  2. Department of Neurology, University of Cincinnati Medical Center, 260 Stetson Street, Suite 2300, Cincinnati, 45267-0525, OH, USA

    Joseph P. Broderick

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O. Adeoye and J. P. Broderick researched the data for the article, provided substantial contributions to discussions of the content, and contributed equally to writing the article and to reviewing and editing the manuscript before submission.

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Correspondence to Opeolu Adeoye.

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O. Adeoye has received honoraria for speaking from EKR Therapeutics, while J. P. Broderick declares research support from Novo Nordisk (this company supplies factor VIIa for the NIH–National Institute of Neurological Disorders and Stroke-funded STOP-IT study).

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Adeoye, O., Broderick, J. Advances in the management of intracerebral hemorrhage. Nat Rev Neurol 6, 593–601 (2010). https://doi.org/10.1038/nrneurol.2010.146

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