Introduction

Traditionally, the treatment of intracerebral hemorrhage (ICH) has been largely empirical. However, this situation is rapidly changing due to the accumulation of data from rigorously conducted, randomized clinical trials that address old treatment quandaries and assess novel and promising therapeutic modalities. Evidence provided by these trials is likely to generate new standards of care for the management of patients with ICH.

Neurologists and neurosurgeons often share uncertainties when faced with patients with large intracerebral hematomas. Questions about appropriateness and timing of surgical intervention to evacuate the hematoma have been pervasive. Several randomized, controlled trials have addressed these questions, and their results offer valuable information to guide our decisions.

Medical treatment of patients with ICH remains mostly supportive, but ultraearly hemo-static therapy and the use of fibrinolytic drugs to accelerate the dissolution of intraventricular clots are strategies with great potential to improve the outcome of these patients. Confirmation of favorable preliminary results from safety trials that tested these treatment modalities may transform the role of clinicians in the management of ICH after many years of therapeutic nihilism.

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