====== Spontaneous intracerebral hemorrhage guidelines ======

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[[Intracerebral hemorrhage]] (ICH) carries the highest [[mortality]] and [[morbidity]] of all [[stroke]] types. Although [[small vessel disease]] accounts for the majority of [[intracerebral hemorrhage]], there is a broad spectrum of other etiologies. Modern [[imaging]] techniques are a [[cornerstone]] of the work-up process. The goals of acute management are to prevent [[hematoma expansion]], stabilize and prevent failure of [[vital signs]], and establish the [[intracerebral hemorrhage etiology]]. ICH expansion can be alleviated by rapid correction of any contributing coagulopathy and antihypertensive treatment. Early prognostication within 24 hours after onset is imprecise. For this reason, international guidelines recommend postponing decision-making on withdrawal or limitation of care until at least the second full day of hospitalization. Indications for intensive care differ from those for neurosurgical treatment and should be assessed separately. Neurosurgical treatment is commonly recommended to reduce mortality in the presence of hydrocephalus or infratentorial hematomas with significant mass effects. In deteriorating patients with supratentorial ICH, surgical treatment can be considered as a life-saving treatment on an individual basis, with consideration given to anatomical location, level of consciousness and medical history
((Mazya M, Bartek J Jr, Hansen B. Modern handläggning av intracerebralt hematom [Treatment of intracerebral hemorrhage - An overview]. Lakartidningen. 2023 Sep 5;120:23056. Swedish. PMID: 37668115.)).
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Medical control of blood pressure and intracranial pressure, among other factors, is key to management. The impact of surgical intervention is less clear
((Bowman KM, Ahmed AS. Surgical Indications and Options for Hypertensive Hemorrhages. Neurol Clin. 2022 May;40(2):337-353. doi: 10.1016/j.ncl.2021.12.001. Epub 2022 Mar 31. PMID: 35465879.)).
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Guidelines from the [[American Heart Association]]/[[American Stroke Association]] (AHA/ASA) recommend that patients with [[ICH]] receive monitoring and management in an [[intensive care unit]]