Skip to main content
SpringerLink
Log in

Advancements in Managing Intracerebral Hemorrhage: Transition from Nihilism to Optimism

  • Chapter
  • First Online:
Medical Science and Research

Part of the book series: Advances in Experimental Medicine and Biology ((CLEXBI,volume 1153))

Abstract

There have been significant advancements in the management of intracerebral hemorrhage (ICH) stemming from new knowledge on its pathogenesis. Major clinical trials, such as Surgical Trial in Lobar Intracerebral Hemorrhage (STICH I and II), have shown only a small, albeit clinically relevant, advantage of surgical interventions in specific subsets of patients suffering from ICH. Currently, the aim is to use a minimally invasive and safe trajectory in removing significant brain hematomas with the aid of neuro-endoscopy or precise guidance through neuro-navigation, thereby avoiding a collateral damage to the surrounding normal brain tissue. A fundamental rational to such approach is to safely remove hematoma, preventing the ongoing mass effect resulting in brain herniation, and to minimize deleterious effects of iron released from hematoma to brain cells. The clot lysis process is facilitated with the adjunctive use of recombinant tissue plasminogen activator and sonolysis. Revised recommendations for the management of ICH focus on a holistic approach, with special emphasis on early patient mobilization and graded rehabilitative process. There has been a paradigm shift in the management algorithm, putting emphasis on early and safe removal of brain hematoma and then focusing on the improvement of patients’ quality of life. We have made significant progress in transition from nihilism toward optimism, based on evidence-based management of such a severe global health scourge as intracranial hemorrhage.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
eBook
USD 84.99
Price excludes VAT (USA)
Softcover Book
USD 109.99
Price excludes VAT (USA)
Hardcover Book
USD 109.99
Price excludes VAT (USA)

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  • Abdu E, Hanley DF, Newell DW (2012) Minimally invasive treatment for intracerebral hemorrhage. Neurosurg Focus 32:E3

    Article  Google Scholar 

  • Alqadri SL, Sreenivasan V, Qureshi AI (2013) Acute hypertensive response management in patients with acute stroke. Curr Cardiol Rep 15:426

    Article  Google Scholar 

  • Anderson CS, Heeley E, Huang Y, Wang J, Stapf C, Delcourt C, Lindley R, Robinson T, Lavados P, Neal B, Hata J, Arima H, Parsons M, Li Y, Wang J, Heritier S, Li Q, Woodward M, Simes RJ, Davis SM, Chalmers J, INTERACT2 Investigators (2013) Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med 368:2355–2365

    Article  CAS  Google Scholar 

  • Arboix A, Comes E, García-Eroles L, Massons J, Oliveres M, Balcells M, Targa C (2002) Site of bleeding and early outcome in primary intracerebral hemorrhage. Acta Neurol Scand 105:282–288

    Article  CAS  Google Scholar 

  • Arboix A, Roig H, Rossich R, Martínez EM, García-Eroles L (2004) Differences between hypertensive and non-hypertensive ischemic stroke. Eur J Neurol 11:687–692

    Article  CAS  Google Scholar 

  • Becker KJ, Baxter AB, Bybee HM, Tirschwell DL, Abouelsaad T, Cohen WA (1999) Extravasation of radiographic contrast is an independent predictor of death in primary intracerebral hemorrhage. Stroke 30:2025–2032

    Article  CAS  Google Scholar 

  • Boulouis G, Morotti A, Goldstein JN, Charidimou A (2017) Intensive blood pressure lowering in patients with acute intracerebral haemorrhage: clinical outcomes and haemorrhage expansion. Systematic review and meta-analysis of randomised trials. J Neurol Neurosurg Psychiatry 88:339–345

    Article  Google Scholar 

  • Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G (1993) Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke 24:987–993

    Article  CAS  Google Scholar 

  • Butcher KS, Jeerakathil T, Hill M, Demchuk AM, Dowlatshahi D, Coutts SB, Gould B, McCourt R, Asdaghi N, Findlay JM, Emery D, Shuaib A, ICH ADAPT Investigators (2013) The intracerebral hemorrhage acutely decreasing arterial pressure trial. Stroke 44:620–626

    Article  Google Scholar 

  • Cai Q, Zhang H, Zhao D, Yang Z, Hu K, Wang L, Zhang W, Chen Z, Chen Q (2017) Analysis of three surgical treatments for spontaneous supratentorial intracerebral hemorrhage. Medicine (Baltimore) 96:e8435

    Article  Google Scholar 

  • Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, White A, Cushman WC, White W, Sica D, Ferdinand K, Giles TD, Falkner B, Carey RM (2008) Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension 51:1403–1419

    Article  CAS  Google Scholar 

  • Chan S, Hemphill JC (2014) Critical care management of intracerebral hemorrhage. Crit Care Clin 30:699–717

    Article  Google Scholar 

  • Chen Y, Xu W, Wang L, Yin X, Cao J, Deng F, Xing Y, Feng J (2018) Transcranial Doppler combined with quantitative EEG brain function monitoring and outcome prediction in patients with severe acute intracerebral hemorrhage. Crit Care 22(1):36

    Article  Google Scholar 

  • Cheung RT, Hachinski V (2004) Cardiac effects of stroke. Curr Treat Options Cardiovasc Med 6:199–207

    Article  Google Scholar 

  • Dastur CK, Yu W (2017) Current management of spontaneous intracerebral haemorrhage. Stroke Vasc Neurol 2(1):21–29

    Article  Google Scholar 

  • Dey M, Stadnik A, Awad IA (2014) Spontaneous intracerebral and intraventricular hemorrhage: advances in minimally invasive surgery and thrombolytic evacuation, and lessons learned in recent trials. Neurosurgery 74(Suppl 1):S142–S150

    Article  Google Scholar 

  • Fan JS, Huang HH, Chen YC, Yen DH, Kao WF, Huang MS, Huang CI, Lee CH (2012) Emergency department neurologic deterioration in patients with spontaneous intracerebral hemorrhage: incidence, predictors, and prognostic significance. Acad Emerg Med 9:133–138

    Article  Google Scholar 

  • Godoy DA, Piñero GR, Koller P, Masotti L, Di Napoli M (2015) Steps to consider in the approach and management of critically ill patient with spontaneous intracerebral hemorrhage. World J Crit Care Med 4:213–229

    Article  Google Scholar 

  • Gregory K, Daniel FH (2018) The systolic blood pressure sweet spot after intracerebral hemorrhage. Neurology 91:495–496

    Article  Google Scholar 

  • Hemphill JC 3rd, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, Fung GL, Goldstein JN, Macdonald RL, Mitchell PH, Scott PA, Selim MH, Woo D, American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology (2015) Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 46:2032–2060

    Article  Google Scholar 

  • Huhtakangas J, Tetri S, Juvela S, Saloheimo P, Bode MK, Hillbom M (2011) Effect of increased warfarin use on warfarin-related cerebral hemorrhage: a longitudinal population-based study. Stroke 42:2431–2435

    Article  CAS  Google Scholar 

  • Jamora RD, Kishi-Generao EM Jr, Bitanga ES, Gan RN, Apaga NE, San Jose MC (2003) The ICH score: predicting mortality and functional outcome in an Asian population. Stroke 34:6–7

    Article  Google Scholar 

  • Jeon JP, Kim C, Kim SE (2018) Blood pressure variability and outcome in patients with acute nonlobar intracerebral hemorrhage following intensive antihypertensive treatment. Chin Med J 131:657–664

    Article  Google Scholar 

  • Kamel H, Navi BB, Nakagawa K, Hemphill JC 3rd, Ko NU (2011) Hypertonic saline versus mannitol for the treatment of elevated intracranial pressure: a meta-analysis of randomized clinical trials. Crit Care Med 39:554–549

    Article  CAS  Google Scholar 

  • Kate MP, Hansen MB, Mouridsen K, Østergaard L, Choi GBE, McCourt R, Hill MD, Demchuk AM, Coutts SB, Dowlatshahi D, Emery DJ, Buck BH, Butcher KS, ICHADAPT Investigators (2014) Blood pressure reduction does not reduce perihematoma oxygenation: a CT perfusion study. J Cereb Blood Flow Metab 34:81–86

    Article  CAS  Google Scholar 

  • Kellner CP, Chartrain AG, Nistal SJ, Hom D, Ghatan S, Bederson JB, Mocco J (2018) The Stereotactic Intracerebral Hemorrhage Underwater Blood Aspiration (SCUBA) technique for minimally invasive endoscopic intracerebral hemorrhage evacuation. J Neurointerv Surg 10:771–776

    Article  Google Scholar 

  • Kidwell CS, Saver JL, Mattiello J, Warach S, Liebeskind DS, Starkman S, Vespa PM, Villablanca JP, Martin NA, Frazee J, Alger JR (2001) Diffusion-perfusion MR evaluation of perihematomal injury in hyperacute intracerebral hemorrhage. Neurology 57:1611–1617

    Article  CAS  Google Scholar 

  • Lattanzi S, Cagnetti C, Provinciali L, Silvestrini M (2017) How should we lower blood pressure after cerebral hemorrhage? A systematic review and meta-analysis. Cerebrovasc Dis 43:207–213

    Article  Google Scholar 

  • Lord AS, Karinja S, Lantigua H, Carpenter A, Schmidt JM, Claassen J, Agarwal S, Connolly ES, Mayer SA, Badjatia N (2014) Therapeutic temperature modulation for fever after intracerebral hemorrhage. Neurocrit Care 21:200–206

    Article  Google Scholar 

  • Lord AS, Gilmore E, Choi HA, Mayer SA, VISTA-ICH Collaboration (2015) Time course and predictors of neurological deterioration after intracerebral hemorrhage. Stroke 46:647–652

    Article  Google Scholar 

  • Mariano GSL, Fink ME, Hoffman C, Rosengart AJ (2012) Intracranial pressure: monitoring and management. In: Hall J, Schmidt G, Wood L (eds) Principles of critical care, 4th edn. McGraw-Hill, New York

    Google Scholar 

  • Martini SR, Flaherty ML, Brown WM, Haverbusch M, Comeau ME, Sauerbeck LR, Kissela BM, Deka R, Kleindorfer DO, Moomaw CJ, Broderick JP, Langefeld CD, Woo D (2012) Risk factors for intracerebral hemorrhage differ according to hemorrhage location. Neurology 79:2275–2282

    Article  Google Scholar 

  • Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, Karimi A, Shaw MD, Barer DH, investigators STICH (2005) Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomized trial. Lancet 365:387–397

    Article  Google Scholar 

  • Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM, STICH II Investigators (2013) Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomized trial. Lancet 382:397–408

    Article  Google Scholar 

  • Messé SR, Sansing LH, Cucchiara BL, Herman ST, Lyden PD, Kasner SE, CHANT investigators (2009) Prophylactic antiepileptic drug use is associated with poor outcome following ICH. Neurocrit Care 11:38–44

    Article  Google Scholar 

  • Morgan T, Zuccarello M, Narayan R, Keyl P, Lane K, Hanley D (2008) Preliminary findings of the minimally-invasive surgery plus rtPA for intracerebral hemorrhage evacuation (MISTIE) clinical trial. Acta Neurochir Suppl 105:147–151

    Article  CAS  Google Scholar 

  • Morgenstern LB, Demchuk AM, Kim DH, Frankowski RF, Grotta JC (2001) Rebleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemorrhage. Neurology 56:1294–1299

    Article  CAS  Google Scholar 

  • Morioka M, Orito K (2017) Management of spontaneous intracerebral hematoma. Neurol Med Chir (Tokyo) 57:563–574

    Article  Google Scholar 

  • Mould WA, Carhuapoma JR, Muschelli J, Lane K, Morgan TC, McBee NA, Bistran-Hall AJ, Ullman NL, Vespa P, Martin NA, Awad I, Zuccarello M, Hanley DF, Investigators MISTIE (2013) Minimally invasive surgery plus recombinant tissue-type plasminogen activator for intracerebral hemorrhage evacuation decreases perihematomal edema. Stroke 44:627–634

    Article  CAS  Google Scholar 

  • Munakomi S (2018) Preventing muscle atrophy following strokes: a reappraisal. Adv Exp Med Biol 1088:593–601

    Article  Google Scholar 

  • Murthy SB, Moradiya Y, Dawson J, Lees KR, Hanley DF, Ziai WC, VISTA-ICH Collaborators (2015) Perihematomal edema and functional outcomes in intracerebral hemorrhage: influence of hematoma volume and location. Stroke 46:3088–3092

    Article  Google Scholar 

  • Naidech AM, Garg RK, Liebling S, Levasseur K, Macken MP, Schuele SU, Batjer HH (2009) Anticonvulsant use and outcomes after intracerebral hemorrhage. Stroke 40:3810–3815

    Article  CAS  Google Scholar 

  • Newell DW, Shah MM, Wilcox R, Hansmann DR, Melnychuk E, Muschelli J, Hanley DF (2011) Minimally invasive evacuation of spontaneous intracerebral hemorrhage using sonothrombolysis. J Neurosurg 115:592–601

    Article  Google Scholar 

  • NINDS ICH Workshop Participants (2005) Priorities for clinical research in intracerebral hemorrhage: report from a National Institute of Neurological Disorders and Stroke workshop. Stroke 36:e23–e41

    Article  Google Scholar 

  • Nyquist P, Bautista C, Jichici D, Burns J, Chhangani S, DeFilippis M, Goldenberg FD, Kim K, Liu-DeRyke X, Mack W, Meyer K (2016) Prophylaxis of venous thrombosis in neurocritical care patients: an evidence-based guideline – a statement for healthcare professionals from the Neurocritical Care Society. Neurocrit Care 24:47–60

    Article  Google Scholar 

  • Ovesen C, Christensen AF, Havsteen I, Hansen CK, Rosenbaum S, Kurt E, Chrustensen H (2015) Prediction and prognostication of neurological deterioration in patients with acute ICH: a hospital-based cohort study. BMJ Open 5:e008563

    Article  Google Scholar 

  • Pai SB, Varma R, Parthiban J, Krishna K, Varma R, Srinivasa R, Acharya PT, Mruthyunjayana BP, Eesha M (2007) Keyhole craniectomy in the surgical management of spontaneous intracerebral hematoma. Neurol Asia 12:21–27

    Google Scholar 

  • Passero S, Ciacci G, Ulivelli M (2003) The influence of diabetes and hyperglycemia on clinical course after intracerebral hemorrhage. Neurology 61:1351–1356

    Article  Google Scholar 

  • Powers WJ, Zazulia AR, Videen TO, Adams RE, Yundt KD, Aiyagari V, Grubb RL Jr, Diringer MN (2001) Autoregulation of cerebral blood flow surrounding acute (6 to 22 hours) intracerebral hemorrhage. Neurology 57:18–24

    Article  CAS  Google Scholar 

  • Przybylowski CJ, Ding D, Starke RM, Webster Crowley R, Liu KC (2015) Endoport-assisted surgery for the management of spontaneous intracerebral hemorrhage. J Clin Neurosci 22:1727–1732

    Article  Google Scholar 

  • Qureshi AI, Geocadin RG, Suarez JI, Ulatowski JA (2000) Long-term outcome after medical reversal of transtentorial herniation in patients with supratentorial mass lesion. Crit Care Med 28:1556–1564

    Article  CAS  Google Scholar 

  • Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF (2001) Spontaneous intracerebral hemorrhage. NEJM 344:1450–1460

    Article  CAS  Google Scholar 

  • Qureshi AI, Palesch YY, Barsan WG, Hanley DF, Hsu CY, Martin RL, Moy CS, Silbergleit R, Steiner T, Suarez JI, Toyoda K, Wang Y, Yamamoto H, Yoon BW, ATACH-2 Trial Investigators and the Neurological Emergency Treatment Trials Network (2016) Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med 375:1033–1043

    Article  Google Scholar 

  • Reichart R, Frank S (2011) Intracerebral hemorrhage, indication for surgical treatment and surgical techniques. Open Crit Care Med J 24:68–71

    Article  Google Scholar 

  • Rodriguez-Luna D, Piñeiro S, Rubiera M, Ribo M, Coscojuela P, Pagola J, Flores A, Muchada M, Ibarra B, Meler P, Sanjuan E, Hernandez-Guillamon M, Alvarez-Sabin J, Montaner J, Molina CA (2013) Impact of blood pressure changes and course on hematoma growth in acute intracerebral hemorrhage. Eur J Neurol 20:1277–1283

    Article  CAS  Google Scholar 

  • Satopää J, Mustanoja S, Meretoja A, Putaala J, Kaste M, Niemelä M, Tatlisumak T, Strbian D (2017) Comparison of all 19 published prognostic scores for intracerebral hemorrhage. J Neurol Sci 379:103–108

    Article  Google Scholar 

  • Smith EE, Rosand J, Greenberg SM (2005) Hemorrhagic stroke. Neuroimaging Clin N Am 15:259–272

    Article  Google Scholar 

  • Spiotta AM, Fiorella D, Vargas J, Khalessi A, Hoit D, Arthur A, Lena J, Turk AS, Chaudry MI, Gutman F, Davis R, Chesler DA, Turner RD (2015) Initial multicenter technical experience with the Apollo device for minimally invasive intracerebral hematoma evacuation. Neurosurgery 11(Suppl 2):243–251

    Article  Google Scholar 

  • Sporns PB, Schwake M, Schmidt R, Kemmling A, Minnerup J, Schwindt W, Cnyrim C, Zoubi T, Heindel W, Niederstadt T, Hanning U (2017) Computed tomographic blend sign is associated with computed tomographic angiography spot sign and predicts secondary neurological deterioration after intracerebral hemorrhage. Stroke 48:131–135

    Article  Google Scholar 

  • Tao C, Hu X, Li H, You C (2017) White matter injury after intracerebral hemorrhage: pathophysiology and therapeutic strategies. Front Hum Neurosci 11:422

    Article  Google Scholar 

  • Teernstra OP, Evers SM, Kessels AH (2006) Meta-analyses in treatment of spontaneous supratentorial intracerebral haematoma. Acta Neurochir 148:521–528

    Article  CAS  Google Scholar 

  • Wang WZ, Jiang B, Liu HM, Li D, Lu CZ, Zhao YD, Sander JW (2009) Minimally invasive craniopuncture therapy vs. conservative treatment for spontaneous intracerebral hemorrhage: results from a randomized clinical trial in China. Int J Stroke 4:11–16

    Article  Google Scholar 

  • Wang X, Arima H, Yang J, Zhang S, Wu G, Woodward M, Muñoz-Venturelli P, Lavados PM, Stapf C, Robinson T, Heeley E, Delcourt C, Lindley RI, Parsons M, Chalmers J, Anderson CS. INTERACT2 Investigators(2015a) Mannitol and outcome in intracerebral hemorrhage: propensity score and multivariable intensive blood pressure reduction in Acute Cerebral Hemorrhage Trial 2 results. Stroke 46:2762–2767

    Article  CAS  Google Scholar 

  • Wang WH, Hung YC, Hsu SP, Lin CF, Chen HH, Shih YH, Lee CC (2015b) Endoscopic hematoma evacuation in patients with spontaneous supratentorial intracerebral hemorrhage. J Chin Med Assoc 78:101–107

    Article  Google Scholar 

  • Yang J, Arima H, Wu G, Heeley E, Delcourt C, Zhou J, Chen G, Wang X, Zhang S, Yu S, Chalmers J, Anderson CS- INTERACT Investigators (2015) Prognostic significance of perihematomal edema in acute intracerebral hemorrhage: pooled analysis from the intensive blood pressure reduction in acute cerebral hemorrhage trial studies. Stroke 46:1009–1013

    Article  Google Scholar 

  • Zazulia AR, Diringer MN, Videen TO, Adams RE, Yundt K, Aiyagari V, Grubb RL Jr, Powers WJ (2001) Hypoperfusion without ischemia surrounding acute intracerebral hemorrhage. J Cereb Blood Flow Metab 21:804–810

    Article  CAS  Google Scholar 

  • Zhang HZ, Li YP, Yan ZC, Wang XD, She L, Wang XD, Dong L (2014) Endoscopic evacuation of basal ganglia hemorrhage via keyhole approach using an adjustable cannula in comparison with craniotomy. Biomed Res Int 2014:898762

    PubMed  PubMed Central  Google Scholar 

  • Zhang HX, Fan QX, Xue SZ, Zhang M, Zhao JX (2018) Twenty-four-hour blood pressure variability plays a detrimental role in the neurological outcome of hemorrhagic stroke. J Int Med Res 46:2558–2568

    Article  Google Scholar 

  • Zheng J, Li H, Zhao HX, Guo R, Lin S, Dong W, Ma L, Fang Y, Tian M, Liu M, Yang F, Meng T, Ming L, You C (2016) Surgery for patients with spontaneous deep supratentorial intracerebral hemorrhage: a retrospective case-control study using propensity score matching. Medicine 95:e3024

    Article  Google Scholar 

  • Zuccarello M, Brott T, Derex L, Kothari R, Sauerbeck L, Tew J, Van Loveren H, Yeh HS, Tomsick T, Pancioli A, Khoury J, Broderick J (1999) Early surgical treatment for supratentorial intracerebral hemorrhage: a randomized feasibility study. Stroke 30:1833–1839

    Article  CAS  Google Scholar 

Download references

Conflicts of Interest

The authors declare no conflicts of interest in relation to this article.

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal

    Sunil Munakomi

  2. Department of Neurosurgery, Narayana Medical College, Nellore, Andra Pradesh, India

    Amit Agrawal

Authors
  1. Sunil Munakomi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amit Agrawal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sunil Munakomi .

Editor information

Editors and Affiliations

  1. Opole Medical School, Opole, Poland

    Mieczyslaw Pokorski

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Munakomi, S., Agrawal, A. (2019). Advancements in Managing Intracerebral Hemorrhage: Transition from Nihilism to Optimism. In: Pokorski, M. (eds) Medical Science and Research. Advances in Experimental Medicine and Biology(), vol 1153. Springer, Cham. https://doi.org/10.1007/5584_2019_351

Download citation

Publish with us

Policies and ethics

Search

Navigation