Spontaneous Intracerebral Hemorrhage

Intracerebral hemorrhage (ICH) represents cerebral parenchymal bleeding that may also extend into ventricular, and rarely, subarachnoid space. As a stroke subtype, it is associated with poor neurological outcome as well as high mortality. The worldwide incidence of ICH ranges from 10 to 20 cases per 100,000 population and increases with age. Different risk factors can cause ICH: hypertension (the main and the most common risk factor), cerebral amyloid angiopathy, previous use of anticoagulant therapy, excessive use of alcohol, and also other risk factors such as serum cholesterol levels and some genetic factors. Its clinical presentation usually consist of a decreased level of consciousness with headache and vomiting (in patients with a large hema-toma), and depending on localization some specific neurological signs could be present: contralateral sensory-motor deficits of varying severity, aphasia, neglect, gaze deviation, hemianopsia, abnormalities of gaze, cranial-nerve abnormalities, as well as ataxia, nystagmus, and dysmetria. Emergency diagnosis and management in neurological intensive care, or stroke units, with hypertension treatment, administration of haemostatic agents and general therapeutic measures for critically ill neurological patients may positively influence the outcome. Nevertheless, a larger number of randomized controlled studies are needed to answer several important questions, including how to treat hypertension, which haemostatic agent to use, as well as determining place and time of surgical treatment. N ontraumatic intracerebral hemorrhage (ICH) represents cerebral parenchymal bleeding that may also extend into ventricular, and rarely, subarachnoid space. ICH, as a stroke subtype, is associated with poor neurological outcome as well as high mortality (about 40% per month) (1, 2). ICH represents around 10–15% of all strokes in Europe, USA and Australia, while in Asia it accounts for about 20–30%. It has been reported that every year 2 million people worldwide have ICH. (2). Despite the fact that reduction in overall age adjusted stroke incidence has been registered, findings of meta-analysis have shown that the incidence of ICH between 1980 and 2008 had not declined (3). ICH can be classified as either primary or secondary, depending on the underlying cause of bleeding (1, 4). (Table 1) Primary ICH is more common (78–88% of cases) and has its origin from chronic hyperten-sion or amyloid angiopathy (1).