Hemorrhagic stroke

Arturo Montaño, Daniel F. Hanley, J. Claude Hemphill

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Hemorrhagic stroke comprises about 20% of all strokes, with intracerebral hemorrhage (ICH) being the most common type. Frequency of ICH is increased where hypertension is untreated. ICH in particularly has a disproportionately high risk of early mortality and long-term disability. Until recently, there has been a paucity of randomized controlled trials (RCTs) to provide evidence for the efficacy of various commonly considered interventions in ICH, including acute blood pressure management, coagulopathy reversal, and surgical hematoma evacuation. Evidence-based guidelines do exist for ICH and these form the basis for a framework of care. Current approaches emphasize control of extremely high blood pressure in the acute phase, rapid reversal of vitamin K antagonists, and surgical evacuation of cerebellar hemorrhage. Lingering questions, many of which are the topic of ongoing clinical research, include optimizing individual blood pressure targets, reversal strategies for newer anticoagulant medications, and the role of minimally invasive surgery. Risk stratification models exist, which derive from findings on clinical exam and neuroimaging, but care should be taken to avoid a self-fulfilling prophecy of poor outcome from limiting treatment due to a presumed poor prognosis. Cerebral venous thrombosis is an additional subtype of hemorrhagic stroke that has a unique set of causes, natural history, and treatment and is discussed as well.

Original languageEnglish (US)
Title of host publicationHandbook of Clinical Neurology
PublisherElsevier B.V.
Pages229-248
Number of pages20
DOIs
StatePublished - Jan 2021

Publication series

NameHandbook of Clinical Neurology
Volume176
ISSN (Print)0072-9752
ISSN (Electronic)2212-4152

Keywords

  • Blood pressure
  • Coagulopathy reversal
  • Hematoma
  • Intracerebral hemorrhage
  • Intraventricular hemorrhage
  • Minimally invasive surgery

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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