Intracerebral Hemorrhage: Acute Evaluation and Management

TL;DRAbstract

As with ischemic stroke, there is a variety of possible presentations for intracerebral hemorrhage. A patient may present with the sudden onset of neurological dysfunction such as weakness, numbness, vision loss, diplopia, dysarthria, gait disorder, vertigo, aphasia, or disturbed level of consciousness. Many symptoms, while possibly occuring also in ischemic stroke, occur more frequently with ICH. These include headache (40%of patient presentations), nausea, and vomiting. In addition, patients with ICH are much more likely to present with a low level of consciousness and hypertension. Finally, the rapidity of neurological worsening is typically more marked than with ischemic strokes. For example, if the hemorrhage is large enough, pressure effects on the whole brain and brainstemmay lead to a markedly diminished level of consciousness. Or a hemorrhage that begins small (2 cm in diameter) may enlarge over the first few hours to become massive. This will lead to a rapid worsening of symp

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