Spontaneous Intracerebral Hemorrhage

This review article examines the pathophysiology, clinical presentation, and management of spontaneous intracerebral hemorrhage (ICH), which accounts for 10–15% of all strokes and carries high morbidity and mortality. ICH typically presents with abrupt focal neurologic signs, impaired consciousness, and headache. Deep hemorrhages from hypertension and lobar hemorrhages from cerebral amyloid angiopathy (CAA) are common subtypes. Risk factors include older age, hypertension, and anticoagulant use. Imaging—CT and MRI—is key for diagnosis, localization, and tracking hematoma expansion, which worsens outcomes. Treatment focuses on mitigating secondary brain injury via blood pressure control, hematoma stabilization, and ventricular drainage for hydrocephalus. Trials show limited benefit from clot evacuation surgery and variable results with intensive antihypertensive strategies. Ongoing studies are evaluating minimally invasive evacuation techniques and recurrence prevention through optimized statin or anticoagulant strategies. Social determinants and disparities affect long-term outcomes. The article emphasizes tailored approaches to therapy, vigilant ICU monitoring, and expanded systems for stroke management.

This review article examines the pathophysiology, clinical presentation, and management of spontaneous intracerebral hemorrhage (ICH), which accounts for 10–15% of all strokes and carries high morbidity and mortality. ICH typically presents with abrupt focal neurologic signs, impaired consciousness, and headache. Deep hemorrhages from hypertension and lobar hemorrhages from cerebral amyloid angiopathy (CAA) are common subtypes. Risk factors include older age, hypertension, and anticoagulant use. Imaging—CT and MRI—is key for diagnosis, localization, and tracking hematoma expansion, which worsens outcomes. Treatment focuses on mitigating secondary brain injury via blood pressure control, hematoma stabilization, and ventricular drainage for hydrocephalus. Trials show limited benefit from clot evacuation surgery and variable results with intensive antihypertensive strategies. Ongoing studies are evaluating minimally invasive evacuation techniques and recurrence prevention through optimized statin or anticoagulant strategies. Social determinants and disparities affect long-term outcomes. The article emphasizes tailored approaches to therapy, vigilant ICU monitoring, and expanded systems for stroke management.