Intracerebral Hemorrhage

Wendy C. Ziai, MD, MPH, FAHA, FNCS, FESO; J. Ricardo Carhuapoma, MD, FAHA p. 1603-1622 December 2018, Vol.24, No.6 doi: 10.1212/CON.0000000000000672
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PURPOSE OF REVIEW: This article describes the advances in the management of spontaneous intracerebral hemorrhage in adults.

RECENT FINDINGS: Therapeutic intervention in intracerebral hemorrhage has continued to focus on arresting hemorrhage expansion, with large randomized controlled trials addressing the effectiveness of rapidly lowering blood pressure, hemostatic therapy with platelet transfusion, and other clotting complexes and clot volume reduction both of intraventricular and parenchymal hematomas using minimally invasive techniques. Smaller studies targeting perihematomal edema and inflammation may also show promise.

SUMMARY: The management of spontaneous intracerebral hemorrhage, long relegated to the management and prevention of complications, is undergoing a recent evolution in large part owing to stereotactically guided clot evacuation techniques that have been shown to be safe and that may potentially improve outcomes.

Address correspondence to Dr J. Ricardo Carhuapoma, Johns Hopkins Hospital, 1800 Orleans St, Phipps 455, Baltimore, MD 21287, jcarhua1@jhmi.edu.

RELATIONSHIP DISCLOSURE: Dr Ziai serves as an associate editor for Neurocritical Care, on an advisory board for C.R. Bard Inc, and has received personal compensation as a consultant for and research/grant support from HeadSense Medical Ltd. Dr Ziai has received grant support from the Johns Hopkins Anesthesiology and Critical Care Medicine (ACCM) Stimulating and Advancing ACCM Research (StAAR) program and from the National Institutes of Health (5U01NS062851, 1U01NS08082). Dr Carhuapoma reports no disclosure.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Drs Ziai and Carhuapoma discuss the unlabeled/investigational use of alteplase for the treatment of intracerebral hemorrhage and discuss the use of several devices, including ultrasound microcatheters, sonothrombolysis for minimally invasive subcortical parafascicular transsulcal access for clot evacuation (MiSPACE), and the stereotactic mechanical (suction/vibration/aspiration) thrombolytic technique for minimally invasive evacuation of intracerebral hemorrhage.

CONTINUUM AUDIO INTERVIEW AVAILABLE ONLINE

© 2018 American Academy of Neurology