Management of spontaneous intracerebral hemorrhage - a review

Abstract

Spontaneous intracerebral hemorrhage (SICH) is defined as a bleeding into the brain parenchyma which occurs in the absence of trauma or surgery. Medical and surgical management of SICH is complex. Medical management comprises of: treatment of arterial hypertension, treatment of increased intracranial pressure, anticonvulsant agents (recommended in supratentorial SICH). Many randomized studies have been conducted to compare surgical and medical management of SICH and the conclusions were not favourable to surgery. Still, early surgical intervention remains an option in some cases. Surgery should be considered in patients with moderate to large lobar or basal ganglia hemorrhages and those with progressive neurological deterioration. Patients with cerebellar hemorrhages larger than 3 cm, with brainstem compression and hydrocephalus and those exhibiting neurological deterioration should undergo surgical evacuation of the clot. Contraindications for surgery are: brainstem hemorrhages, small hemorrhages, elderly patients with Glasgow Coma Scale score less than 5. Evidence-based recommendations regarding the role of surgery in SICH are needed.