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Highly Accessed Open Badges Review

Clinical review: Critical care management of spontaneous intracerebral hemorrhage

Fred Rincon1 and Stephan A Mayer2*

Author Affiliations

1 Department of Medicine, Cooper University Hospital, The Robert Wood Johnson Medical School University of Medicine and Dentistry of New Jersey, Camden, NJ 08501, USA

2 Neurological Intensive Care Unit, Division of Stroke and Critical Care, Department of Neurology and the Department of Neurosurgery, College of Physicians and Surgeons (SAM), Columbia University, New York, NY 10032, USA

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Critical Care 2008, 12:237  doi:10.1186/cc7092

Published: 10 December 2008


Intracerebral hemorrhage is by far the most destructive form of stroke. The clinical presentation is characterized by a rapidly deteriorating neurological exam coupled with signs and symptoms of elevated intracranial pressure. The diagnosis is easily established by the use of computed tomography or magnetic resonance imaging. Ventilatory support, blood pressure control, reversal of any preexisting coagulopathy, intracranial pressure monitoring, osmotherapy, fever control, seizure prophylaxis, treatment of hyerglycemia, and nutritional supplementation are the cornerstones of supportive care in the intensive care unit. Dexamethasone and other glucocorticoids should be avoided. Ventricular drainage should be performed urgently in all stuporous or comatose patients with intraventricular blood and acute hydrocephalus. Emergent surgical evacuation or hemicraniectomy should be considered for patients with large (>3 cm) cerebellar hemorrhages, and in those with large lobar hemorrhages, significant mass effect, and a deteriorating neurological exam. Apart from management in a specialized stroke or neurological intensive care unit, no specific medical therapies have been shown to consistently improve outcome after intracerebral hemorrhage.