Acute treatment of intracerebral haemorrhage: blood pressure and haemostasis

What it is

A 58-year-old man reaches the ER 2h after right-sided weakness begins. He has hypertension and chronic kidney disease and takes amlodipine, lisinopril and aspirin. He is awake and interactive, BP 190/88 mm Hg, and papilledema is noted. The neurologic examination shows right-sided facial weakness, slurred speech and absent movement and pinprick sensation in the right arm and leg, but no aphasia. A CT scan of the head without contrast shows a left thalamic intracerebral hemorrhage.

The elderly hypertensive patient who presents with LOC carries the same diagnosis, there with intraventricular hemorrhage as well. Once the CT shows the hemorrhage, treatment turns on two things: bringing the pressure down and correcting the coagulopathy.

How it is diagnosed

Select patients with ICH should be considered for an elective MRI or CT angiographic study to exclude an underlying lesion such as an aneurysm, an AV malformation or a tumor.