Intracerebral hemorrhage.
BACKGROUND
Intracerebral hemorrhage (ICH) occurs from the rupture of small vessels into the brain parenchyma and accounts for approximately 10% of all strokes in the United States, and carries with it a significantly high morbidity and mortality.


CONCLUSIONS
This article reviews the course and management of ICH. The most common chronic vascular diseases that lead to ICH are chronic hypertension and cerebral amyloid angiopathy. Additional factors that predispose to ICH include vascular malformations, chronic alcohol use, hypocholesterolemia, and use of anticoagulant medications. The understanding of mechanisms leading to ICH has advanced significantly, but questions regarding site predilection and timing of spontaneous hemorrhage still remain. Management in the acute setting is first focused on reducing hematoma expansion. Although no specific therapy has yet been proven effective, promising agents, particularly recombinant Factor VIIa, are on the horizon. Subsequent care is focused on controlling hemostasis, hemodynamics, and intracranial pressure in efforts to minimize secondary brain injury.


CONCLUSIONS
The morbidity and mortality associated with ICH remain high despite recent advances in our understanding of the clinical course of ICH. Novel preventive and acute treatment therapies are needed and may be on the horizon.
Badjatia
Neeraj
N
Neurocritical Care and Acute Stroke Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. nbadjatia@neuro.columbia.edu
Rosand
Jonathan
J
D000925:Anticoagulants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D016657:Cerebral Amyloid Angiopathy / Q000150:complications; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D002561:Cerebrovascular Disorders / Q000150:complications; D004636:Emergency Service, Hospital; D005167:Factor VII / Q000627:therapeutic use; D006801:Humans; D007427:Intracranial Pressure; D009997:Osmotic Pressure; D012307:Risk Factors
D000925:Anticoagulants; D000959:Antihypertensive Agents; D005167:Factor VII