Intracerebral Hemorrhage

In the case of intracerebral hemorrhage, there is no clinically proven specific medical or surgical therapy, and general medical management is similar to that for patients with ischemic infarction. In addition, any clotting disorders must be corrected. Brain swelling or mass effect of the hemorrhage that blocks the flow of CSF or compresses the brainstem or other structures may require surgical intervention. Large cerebellar hemorrhages are often evacuated to relieve pressure on the brainstem.

At present, the prognosis for patients with large or medium size hemorrhages is usually grave. However patients with smaller hemorrhages can experience a slow but remarkable return of function. Apparently a hemorrhage can sometimes push aside brain tissue and disable it temporarily without destroying it. As the blood is slowly reabsorbed, function returns.

Prevention

Although there is no conclusive evidence, most stroke experts believe that treatment of hypertension is probably the most effective means of preventing most intracerebral hemorrhages. It is also clear that careful control of anticoagulation levels in patients receiving warfarin and careful selection of patients for thrombolytic therapy (whether for acute MI or stroke) should also decrease the rate of intracerebral hemorrhage.