Spontaneous Intracerebral Hemorrhage

Abstract Spontaneous intracranial hemorrhage (ICH) is the second most common case of stroke and has 30-day mortality estimated at 44% to 52%. ICH is most commonly caused by arterial hypertension, followed by cerebral amyloid angiopathy, vascular malformations, ruptured aneurysms, and tumors. The signs and symptoms of ICH depend on the location and size of the hemorrhage and have a gradual onset over a period of minutes to hours. Imaging studies are the primary diagnostic tool for detecting ICH, and CT is being considered the “gold standard” for identifying acute hemorrhage. A contrast-enhanced MRI or CT angiography is useful to detect underlying causative lesions such as tumors or vascular malformations. Management of ICH includes both medical and surgical treatment. Medical therapy aims to stabilize the patient and prevent hemorrhage extension by focusing on blood pressure control, reversal of coagulopathies, and treatment of intracranial hypertension. Surgical management was historically mainly limited to evacuation of the hematoma via open craniotomy, but minimally invasive surgical approaches are increasingly employed. These include but are not limited to catheter-based thrombolytic therapy, endoscopic evacuation, and ultrasonic lysis of the hematoma. This chapter details the etiology, pathophysiology, presentation, diagnosis, and treatment of spontaneous ICH.