Intracerebral hemorrhage (ICH) is associated with the highest mortality of all cerebrovascular events, with morbidity and mortality as high as 40%. Furthermore, the majority of ICH survivors never regain functional independence (1). The guidelines for the management of spontaneous ICH, released by a Special Writing Group of the American Heart Association (AHA) in 1999, have set the framework for the care of ICH patients and for future clinical research in this area of cerebrovascular neurology (2). This chapter is largely based on the fundamental principles developed by this AHA group, as well as on the report from the National Institutes of Neurological Disorders and Stroke (NINDS) Workshop, which studied the priorities for clinical research in this field (3).

The management of patients with ICH can be broadly divided into the following categories:

  1. Emergent management Airway Breathing Circulation
  2. Preventionofhematoma growth Blood pressure management Correction of coagulopathies

Hemostasis manipulation (clot lysis, recombinant Factor VIIa)

3. Treatment ofsecondary complications Increased intracranial pressure (ICP) Herniation syndromes

Cerebral edema Seizures

4. Treatment of precipitating factor

Aneurysms, arteriovenous malformations, hypertension

5. Other Management of fever

Deep venous thrombosis (DVT), gastrointestinal (GI) prophylaxis Rehabilitation .

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