SFGH 2.24 AM report pearls: intracerebral hemorrhage

AHA/ASA guidelines for management of spontaneous intracerebral hemorrhage (ICH)

  • vomiting, SBP >220, severe headache, coma or decreased level of consciousness, and symptom progression over minutes or hours suggest ICH, none are specific
  • CT is the gold standard for diagnosis
  • spot sign on CT with contrast (presence of contrast within the hematoma) – identifies patients at high risk of ICH expansion and subsequent poor outcome
  • management:
    • patients with coagulopathy or severe thrombocytopenia should receive factor replacement or platelets, respectively
    • those on warfarin should have reversal with IV vitamine K or PCCs (e.g. Kcentra)
    • for ICH patients with SBP 150-220, acute lowering of SBP to 140 is safe and can be effective for improving functional recovery
    • it is a class IIb recommendation to consider aggressive reduction of BP with pts with SBP >220
    • prophylactic antiseizure medication is not recommended, but patients with clinical seizures should be treated
    • early surgery for hematoma evacuation is not recommended, but surgery is recommended for those with cerebellar hemorrhage with deterioration, ventricular obstruction, neurologic deterioration, brainstem compression or severe disease


  1. C. Hemphill III, S. M. Greenberg, C. Anderson et al., “Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association,” Stroke, vol. 46, no. 7, pp. 2032–2060, 2015.



Evernote link: http://www.evernote.com/l/AoOpIZc9CRFBBqvkDhwSA-P-mXtO1gW6i5w/



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