REVIEW – October 2022

Management of spontaneous intracranial haemorrhage

Authors: Marie Laanisto

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Spontaneous intracranial hemorrhage is a neurological emergency and its key management includes aggressive blood pressure treatment (<140 mm Hg <1 hour), reversal of anticoagulation (anticoagulant-related haemorrhage), prompt etiologic diagnosis and consideration of surgical management. As its clinical presentation is very similar to that of acute ischaemic stroke, neuroimaging is crucial in establishing the diagnosis. In addition to hypertension and coagulopathy, the etiology may also be amyloidangiopathy,
structural cause or systemic disease. There is not enough evidence to support surgical intervention on a routine basis, but early surgery may be of value in the case of cerebellar
haematoma, hydrocephalus or brainstem compression. Haemorrhage may also extend to the ventricles and may need a ventricular
drain or monitoring of intracerebral pressure. Secondary prevention is based on blood pressure control and the overall strategy should consider prevention of recurrent bleeding, as well as the frequently increased risk of thromboembolic ischaemic events.