Conclusion

Despite no single proven effective therapy, the prognosis of ICH has appeared to improve in the past 20 years, in part because of the ability to identify smaller hemorrhages by modern imaging but perhaps also because of modern neurointensive care (75). It has even been suggested that the accuracy of some of the models discussed above might reflect a "self-fulfilling prophecy" in which care is not provided to those deemed unlikely to survive, when, in fact, aggressive treatment could result in "reasonable" neurologic outcomes (76). Although this thesis remains difficult to either be verified or disproved, the congruence of many predictors of short-term mortality and long-term disability suggests that even the most sophisticated aggressive care still has a limited impact on outcome, however it is measured. Smaller observational studies have given way to larger, more sophisticated analyses, which have identified factors that can serve as targets for specific interventions, such as hematoma expansion, IVH, hydrocephalus, and elevated blood pressure.

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