الفهرس 
Basic consideration about intracerebral hemorrhageOnly 14 pages are availabe for public view
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Abstract
Intracerebral hemorrhage account for only 15% of all strokes but it is one of the most disabling forms of stroke. It has the highest mortality rate of all stroke subtypes. ICH has 30 day mortality rate of 35% to 52%.
The methods for managing ICH are broadly divided into two categories: medical and surgical interventions. Medical management includes cardiopulmonary optimization and blood pressure control, ICP reduction (using, for example, patient positioning, hyperosmolar fluids, hyperventilation, and barbiturate coma), general medical management (including careful glucose management) and reversing coagulation defects.
Blood pressure is commonly elevated at the time of presentation with ICH. Several clinical trials are underway to test the safety and efficacy of various acute blood pressure lowering strategies after ICH such as Intensive B.P reduction in acute cerebral hemorrhage (INTERACT) study and Antihypertensive treatment in acute cerebral hemorrhage (ATACH) trial, Preliminary reports suggest that these strategies are feasible, safe, and may favorably affect hematoma expansion to stunt hematoma growth which is a major cause of morbidity and mortality in ICH.The American Stroke Association recommends blood pressure lowering to a target of 160/90 mm Hg (or mean arterial pressure 110 mm Hg) in those not suspected of having increased ICP and frequent clinical monitoring for neurological deterioration.
The Surgical Trial in Intracerebral Hemorrhage (STICH) is the largest randomized trial to date comparing surgical hematoma evacuation to medical therapy in 1033 patients with spontaneous ICH. Although STICH showed no significant overall benefit in outcomes after surgery, approximately a quarter of subjects crossed over from the medical arm and underwent surgery. Additionally, post hoc analyses suggested a possible benefit in patients with superficial lobar ICH (i.e., less than1 cm from the cortical surface) and those receiving open craniotomy. STICH II is an ongoing multicenter, randomized clinical trial, testing the surgical hypothesis in patients with superficial lobar ICH.
The Minimally Invasive Surgery plus t-PA for Intracerebral Hemorrhage Evacuation (MISTIE) study is a multicenter, Randomized clinical trial assessing the utility of astereotactically placed catheter for clot drainage facilitated by intraclot t-PA infusion. The CLEAR IVH trial tested removing IVH with catheter delivered recombinant tissue plasminogen activator. The initial results of the CLEAR IVH trial are consistent with the proposition that a protocol for removal of intraventricular clot from ICH subjects with small, stable parenchymal clots (ICH size < 30 cm3) can produce close to 50% good functional outcomes as defined by modified Rankin score at 180 days.