Advances in the care of patients with intracerebral hemorrhage.
Intracerebral hemorrhage (ICH), which comprises 15 percent to 30 percent of all strokes, has an estimated incidence of 37,000 cases per year. One third of patients are actively bleeding when they present to the emergency department, and hematoma growth during the first hours after ICH onset is thought to be a prime determinant of clinical deterioration. Inflammation, as opposed to ischemia, also negatively affects patient condition. Recombinant activated factor VII is emerging as a potential first-line therapy, especially in warfarin-associated hemorrhage. Corticosteroid therapy is not supported by contemporary studies or by current management guidelines. Aggressive blood pressure reduction is under investigation. Surgical intervention has shown no statistically significant benefit over medical management for patients with ICH in general, although subgroup analysis in a large randomized trial suggested potential benefits from surgery for patients with lobar ICH. Not long ago, ICH was considered virtually untreatable. Diligent efforts in both bench and clinical research are generating hope for patients who experience this catastrophic event.
Thompson
Kristine M
KM
Department of Emergency Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA. thompson.kristine@mayo.edu
Gerlach
Sharon Y
SY
Jorn
H Keels S
HK
Larson
Jan M
JM
Brott
Thomas G
TG
Files
Julia A
JA
D000925:Anticoagulants / Q000009:adverse effects; D001794:Blood Pressure / Q000502:physiology; D002543:Cerebral Hemorrhage / Q000517:prevention & control / Q000628:therapy*; D003029:Coagulants / Q000627:therapeutic use; D005167:Factor VII / Q000627:therapeutic use; D015942:Factor VIIa; D006801:Humans; D011994:Recombinant Proteins / Q000627:therapeutic use; D020521:Stroke / Q000628:therapy; D014859:Warfarin / Q000009:adverse effects
D000925:Anticoagulants; D003029:Coagulants; D011994:Recombinant Proteins; D014859:Warfarin; D005167:Factor VII; C103587:recombinant FVIIa; D015942:Factor VIIa