Advances in the management of intracerebral hemorrhage

Intracerebral hemorrhage (ICH) is one of the most detrimental sub-types of stroke and accounts for 10-15 % of all strokes Qureshi et al. (Lancet 373(9675): 1632-1644, 2009). ICH has an incidence of 10-30 cases per 100,000 people/year which is increasing and expected to double by the year 2050 Qureshi et al. (N Engl J Med 344 (19): 1450-1460, 2001). Mortality rates still remain poor (30-50 %) and functional dependency after ICH is high (similar to 75 %) van Asch et al. (Lancet Neurol 9 (2): 167-176, 2010). Up to now, all randomized controlled trials investigating treatment approaches in ICH have failed to document improvements on clinical end-points Mayer et al. (N Engl J Med 358 (20): 2127-2137, 2008); Brouwers and Goldstein (Neurotherapeutics 9 (1): 87-98, 2012). Only a specialized treatment of severely injured patients at dedicated neuro intensive care units [NICU] has been shown to be beneficial Qureshi et al. (Lancet 373(9675): 1632-1644, 2009); Suarez et al. (Crit Care Med 32 (11): 2311-2317, 2004). Currently, ongoing trials are investigating aggressive blood pressure lowering, hemostatic therapies, different operative strategies, intraventricular thrombolysis as well as neuroprotective approaches, and brain edema therapies. This review will summarize advanced treatment strategies and novel approaches which are currently under investigation.