title: European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage.
abstract: BACKGROUND
  Intracerebral hemorrhage (ICH) accounted for 9% to 27% of all strokes worldwide in the last decade, with high early case fatality and poor functional outcome. In view of recent randomized controlled trials (RCTs) of the management of ICH, the European Stroke Organisation (ESO) has updated its evidence-based guidelines for the management of ICH.
  
  
  METHODS
  A multidisciplinary writing committee of 24 researchers from 11 European countries identified 20 questions relating to ICH management and created recommendations based on the evidence in RCTs using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
  
  
  RESULTS
  We found moderate- to high-quality evidence to support strong recommendations for managing patients with acute ICH on an acute stroke unit, avoiding hemostatic therapy for acute ICH not associated with antithrombotic drug use, avoiding graduated compression stockings, using intermittent pneumatic compression in immobile patients, and using blood pressure lowering for secondary prevention. We found moderate-quality evidence to support weak recommendations for intensive lowering of systolic blood pressure to <140 mmHg within six-hours of ICH onset, early surgery for patients with a Glasgow Coma Scale score 9-12, and avoidance of corticosteroids.
  
  
  CONCLUSIONS
  These guidelines inform the management of ICH based on evidence for the effects of treatments in RCTs. Outcome after ICH remains poor, prioritizing further RCTs of interventions to improve outcome.
authors.affiliation: Department of Neurology, Klinikum Frankfurt Höchst, Frankfurt, Germany; Department of Neurology, Heidelberg University, Heidelberg, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Steiner
authors.forename: Rustam
authors.initials: R
authors.lastname: Al-Shahi Salman
authors.forename: Ronnie
authors.initials: R
authors.lastname: Beer
authors.forename: Hanne
authors.initials: H
authors.lastname: Christensen
authors.forename: Charlotte
authors.initials: C
authors.lastname: Cordonnier
authors.forename: Laszlo
authors.initials: L
authors.lastname: Csiba
authors.forename: Michael
authors.initials: M
authors.lastname: Forsting
authors.forename: Sagi
authors.initials: S
authors.lastname: Harnof
authors.forename: Catharina J M
authors.initials: CJ
authors.lastname: Klijn
authors.forename: Derk
authors.initials: D
authors.lastname: Krieger
authors.forename: A David
authors.initials: AD
authors.lastname: Mendelow
authors.forename: Carlos
authors.initials: C
authors.lastname: Molina
authors.forename: Joan
authors.initials: J
authors.lastname: Montaner
authors.forename: Karsten
authors.initials: K
authors.lastname: Overgaard
authors.forename: Jesper
authors.initials: J
authors.lastname: Petersson
authors.forename: Risto O
authors.initials: RO
authors.lastname: Roine
authors.forename: Erich
authors.initials: E
authors.lastname: Schmutzhard
authors.forename: Karsten
authors.initials: K
authors.lastname: Schwerdtfeger
authors.forename: Christian
authors.initials: C
authors.lastname: Stapf
authors.forename: Turgut
authors.initials: T
authors.lastname: Tatlisumak
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Thomas
authors.forename: Danilo
authors.initials: D
authors.lastname: Toni
authors.forename: Andreas
authors.initials: A
authors.lastname: Unterberg
authors.forename: Markus
authors.initials: M
authors.lastname: Wagner
mesh_terms: D002543:Cerebral Hemorrhage / Q000628:therapy*; D019468:Disease Management; D006801:Humans; D016032:Randomized Controlled Trials as Topic
keywords: anticoagulation; antiepileptic treatment; antihypertensive treatment; intracranial hemorrhage; intracranial pressure; management