Guidelines for the Management of Spontaneous Intracerebral Hemorrhage

TLDR

The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of spontaneous intracerebral hemorrhage. The guideline was developed through a systematic PubMed literature search, expert committee deliberations, and AHA/ASA evidence grading, with prerelease peer review. The guideline presents evidence‑based recommendations for diagnosis, coagulopathy and blood‑pressure management, secondary injury prevention, surgical decision‑making, outcome prediction, rehabilitation, and secondary prevention, incorporating recent phase‑3 trials and emphasizing early aggressive care.

Abstract

Purpose— The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of spontaneous intracerebral hemorrhage. Methods— A formal literature search of PubMed was performed through the end of August 2013. The writing committee met by teleconference to discuss narrative text and recommendations. Recommendations follow the American Heart Association/American Stroke Association methods of classifying the level of certainty of the treatment effect and the class of evidence. Prerelease review of the draft guideline was performed by 6 expert peer reviewers and by the members of the Stroke Council Scientific Oversight Committee and Stroke Council Leadership Committee. Results— Evidence-based guidelines are presented for the care of patients with acute intracerebral hemorrhage. Topics focused on diagnosis, management of coagulopathy and blood pressure, prevention and control of secondary brain injury and intracranial pressure, the role of surgery, outcome prediction, rehabilitation, secondary prevention, and future considerations. Results of new phase 3 trials were incorporated. Conclusions— Intracerebral hemorrhage remains a serious condition for which early aggressive care is warranted. These guidelines provide a framework for goal-directed treatment of the patient with intracerebral hemorrhage.