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• Intracerebral hemorrhage


  10% of strokes, 2nd cause after ischemic
• Risk factors for intracerebral hemorrhage


  • HTN
  • Alcohol
  • Age
  • Smoking
  • Illicit drugs
  • Tumor
  • Cerebral amyloid angiopathy
  • Vascular malformation
  • Coagulopathies
  • Anticoagulation Tx
• Most common causes of intracerebral hemorrhage


  • HTN: deep white matter (BG, BS, thalamus, cerebellum, pons)
  • Hyaline arteriosclerosis (lipohyalinosis)
  • Charcot bouchard microaneurysms
  • Slit hemorrhages
  • Cerebral amyloid angiopathy: lobar hemorrhage
• Cerebral amyloid angiopathy


  Related to Alzheimer's: B-amyloid, apo E mutation (E4 is a RF, E2 is protective)
• Presentation of intracerebral hemorrhage


  • Focal motor/sensory deficit, progressively worsens over time as the hematoma expands
  • LOC, features of increased ICP ± seizures
• Immediate non-contrast CT is MANDATORY
• Treatment of intracerebral hemorrhage


  1. Stop anticoagulants & reverse w/ prothrombin complex concentration

  2. Control HTN (most important step): target SBP 140-160

  3. IV infusion of anti-HTN: Labetalol or Nicardipine (CCB) with monitoring

  4. Decreased ICP: elevating head of bed, hyperventilation (fastest way to decrease ICP) & mannitol

  5. Seizures: IV anti-epileptics

  6. If large bleed/coma/BS compression/hydrocephalus→neurosurgery

  7. VTE prophylaxis w/ IPC