Intracerebral haemorrhage (ICH): general medical management
Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .
Intracerebral haemorrhage (ICH): general medical management. This is started as soon possible after onset of ICH. Fully referenced neurology checklist.
Blood pressure treatment
- This is started as soon possible after onset of ICH
- Aim for mean systolic BP of 130-139mmHg in the first 24 hours
- Long term aim is blood pressure <130/80mmHg
- Agents: Labetolol, Esmolol, Nicardipine, Enalaprilat, Fenoldopam
Seizure management
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Prevent deep vein thrombosis (DVT)
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Other treatments
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Precautions
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Investigational treatments
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References
- Morgenstern LB, Hemphill III JC, Anderson C, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Strike Association. Stroke 2010; 41:2108-2129.
- Mayer SA, Chong J. Critical care management of increased intracranial pressure. J Int Care Med 2002; 17: 55-67.
- Greenberg SM, Ziai WC, Cordonnier C, et al. 2022 guideline for the management of patients with spontaneous intracerebral hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke 2022; 53:e282-e361.
- Burroughs-Ray DC, VanDillen AF, Jackson CD. Clinical guideline highlights for the hospitalist: 2022 American Heart Association/American Stroke Association Guideline for the management of patients with spontaneous intracerebral hemorrhage. J Hosp Med 2023; 18:624-626.
- Rincon F, Mayer SA. Clinical review: critical care management of spontaneous intracerebral hemorrhage. Critical Care 2008; 12:237.
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