Emerging medical and surgical management strategies in the evaluation and treatment of intracerebral hemorrhage

Edward M. Manno, John L D Atkinson, Jimmy R. Fulgham, Eelco F M Wijdicks

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73 Citations (Scopus)

Abstract

Intracerebral hemorrhage (ICH) accounts for approximately 10% of all strokes and causes high morbidity and mortality. Rupture of the small perforating vessels of the cerebral arteries is caused by chronic hypertension, which induces pathologic changes in the small vessels and accounts for most cases of ICH; however, amyloid angiopathy and other secondary causes are being seen more frequently with the increasing age of the population. Recent computed tomographic studies have revealed that ICH is a dynamic process with up to one third of initial hemorrhages expanding within the first several hours of ictus. Secondary injury is believed to result from the development of cerebral edema and the release of specific neurotoxins associated with the breakdown products of hemoglobin. Treatment is primarily supportive. Surgical evacuation is the treatment of choice for patients with neurologic deterioration from infratentorial hematomas. Randomized trials comparing surgical evacuation to medical management have shown no benefit of surgical removal of supratentorial hemorrhages. New strategies focusing on early hemostasis, improved critical care management, and less invasive surgical techniques for clot evacuation are promising to decrease secondary neurologic injury. We review the pathophysiology of ICH, its medical management, and new treatment strategies for improving patient outcome.

Original languageEnglish (US)
Pages (from-to)420-433
Number of pages14
JournalMayo Clinic Proceedings
Volume80
Issue number3
StatePublished - 2005

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Cerebral Hemorrhage
Hemorrhage
Nervous System Trauma
Cerebral Arteries
Brain Edema
Neurotoxins
Therapeutics
Critical Care
Hemostasis
Hematoma
Nervous System
Rupture
Hemoglobins
Stroke
Hypertension
Morbidity
Mortality
Wounds and Injuries
Population

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Manno, E. M., Atkinson, J. L. D., Fulgham, J. R., & Wijdicks, E. F. M. (2005). Emerging medical and surgical management strategies in the evaluation and treatment of intracerebral hemorrhage. Mayo Clinic Proceedings, 80(3), 420-433.

Emerging medical and surgical management strategies in the evaluation and treatment of intracerebral hemorrhage. / Manno, Edward M.; Atkinson, John L D; Fulgham, Jimmy R.; Wijdicks, Eelco F M.

In: Mayo Clinic Proceedings, Vol. 80, No. 3, 2005, p. 420-433.

Research output: Contribution to journalArticle

Manno, EM, Atkinson, JLD, Fulgham, JR & Wijdicks, EFM 2005, 'Emerging medical and surgical management strategies in the evaluation and treatment of intracerebral hemorrhage', Mayo Clinic Proceedings, vol. 80, no. 3, pp. 420-433.
Manno, Edward M. ; Atkinson, John L D ; Fulgham, Jimmy R. ; Wijdicks, Eelco F M. / Emerging medical and surgical management strategies in the evaluation and treatment of intracerebral hemorrhage. In: Mayo Clinic Proceedings. 2005 ; Vol. 80, No. 3. pp. 420-433.
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