Intracerebral hemorrhage: An overview of etiology, pathophysiology, clinical presentation, and advanced treatment strategies

Intracerebral hemorrhage (ICH) is one of the most detrimental subtypes of stroke and accounts for 10-15% of all strokes. ICH has an incidence of 10-30 cases per 100,000/year and is increasing. Mortality rates still remain poor (30-50%), and functional dependency after ICH is high (75%). Up to now, all randomized controlled trials investigating treatment approaches in ICH have failed to document improvements on clinical endpoints. Only a specialized treatment of severely injured patients at dedicated comprehensive stroke centers and neurointensive care units (NICUs) has been shown to be beneficial. Currently, ongoing trials are investigating aggressive blood pressure lowering, hemostatic therapies, different operative strategies, and intraventricular thrombolysis, as well as neuroprotective approaches and brain edema therapies. This chapter will summarize the etiology, pathophysiology, advanced treatment strategies, and novel approaches which are currently under investigation.