The management of spontaneous primary intracerebral haemorrhage

Intracerebral haemorrhage (ICH) accounts for around 10-20% of all strokes and results from a variety of disorders. ICH is more likely to result in death or major disability than ischaemic stroke or subarachnoid haemorrhage. Rapid imaging allows early diagnosis and characterization of the localization and severity of the haemorrhage. Patients with significant acute ICH should be managed in a critical care unit. Treatment entails general supportive care, control of blood pressure (BP) and intracranial pressure (ICP), prevention of haematoma expan-sion and, where indicated, neurosurgical intervention. Those patients whose bleed extends into the ventricular system or who have infraten-torial bleeds are at increased risk of associated hydrocephalus, rapidly increasing ICP requiring urgent cerebrospinal fluid drainage. The 30 -day mortality from ICH ranges from 35% to 52%. Among survivors, the prognosis for functional recovery depends upon the location of haemorrhage, size of the haematoma, level of consciousness, and the patient's and overall medical condition.