Advances in the Treatment and Management of Intracerebral Hemorrhage

Currently there are no “gold standards of care” in place for the treatment of intracerebral hemorrhage (ICH). Clinical trial data have indicated that the largest expansion of the hemorrhage volume occurs within the early hours after the onset of symptoms. This expansion of hematoma volume has been shown to be a critical factor in predicting mortality 30 days postictus. Thus, it is reasonable that minimizing hematoma growth, and any associated perihematomal edema, could potentially provide clinical benefit, reduce the degree of neurological damage, improve functional outcomes, and reduce mortality. Traditionally, surgical interventions were the only option for improving patient outcome or preventing mortality. There has been a great deal of debate surrounding the clinical benefit of surgery. The results of the International Surgical Trial in Intracerebral Hemorrhage conclusively demonstrated that there was no clear advantage gained by the early surgical evacuation of hematomas, as compared with conservative treatment. The results of a recently concluded clinical trial of ICH patients demonstrated that the early administration of the hemostatic agent, recombinant activated coagulation factor VIIa, within 4 hours of the onset of symptoms, reduced hematoma expansion as compared with placebo. In addition, the treatment of ICH patients with recombinant activated coagulation factor VIIa also demonstrated significant improvements in several neurological, functional, and disability scales. This review will summarize the current understanding, provide an overview of new treatment trends, and suggest potential strategies for future investigations into ICH.