Management of non-traumatic, non-aneurismal intracerebral hemorrhage

Abstract

Background: Intracerebral hemorrhage is the second most common form of stroke after ischemic stroke. Common causes of spontaneous intracerebral hemorrhage are: hypertension, amyloid angiopathy, aneurysmal hemorrhages and vascular malformations. The purpose of this study was to evaluate the modalities of medical and surgical management of patients with non-traumatic intracerebral hemorrhage. Non-traumatic intracerebral hemorrhages account for 9 to 27% of all strokes worldwide. In total, the incidence of intracerebral hemorrhage varies from 12 to 31 cases per 100.000 patients. The incidence of intracerebral hemorrhages increases with age, doubling every 10 years after the age of 35. Neuroimaging is clinically important for the rapid diagnosis of intracerebral hemorrhage and the underlying etiology, but also for identifying the risk of hematoma growth, often associated with an unfavorable prognosis. Assessing the risk of hematoma expansion is both an opportunity for therapeutic intervention and a potential danger to hematoma removal surgeries. Mortality at 30 days after intracerebral hemorrhage ranges from 35 to 52%. Half of the deaths occurs in the first 2 days after onset. Conclusions: Despite the lack of a specific course of treatment for intracerebral hemorrhages, the mortality rate has decreased in recent decades, possibly due to advanced supportive treatment and better control of risk factors and secondary prevention. The reduction in mortality is, however, counteracted by the increase in the number of neurologically deficient survivors