Management of primary intracerebral hemorrhage

BACKGROUND: Primary intracranial hemorrhage (PICH) is responsible for about 10% of all strokes and is associated with a grave prognosis with high morbidity and mortality rates. OBJECTIVES: To familiarize the reader with new insights gained in the field of PICH over recent years. METHODS: The authors conducted a MEDLINE search on studies related to the diagnosis and therapy of PICH. The authors also formed an expert committee of the Israeli Neurological Society that discussed the epidemiology, prevention, diagnosis and therapy of PICH and present their conclusions herein. RESULTS AND DISCUSSION: PICH is a common and serious disorder with ominous prognosis. A large proportion of all PICH could theoretically be prevented if appropriate therapeutic interventions would be applied in advance. This holds especially true for lowering systolic and diastolic blood pressure. Conservative therapy continues to be the most appropriate therapy form to date although it only marginally improves patient outcome and survival. Surgical interventions have not proved to be superior to conservative therapy thus far, except for certain forms of PICH as detailed in the article. However, newer surgical techniques that are currently undergoing randomized studies could perceivably improve patients survival and outcome.