[The medical treatment of intracerebral hemorrhage]

To review the main aspects of the practical management of intracerebral hemorrhage.

We begin by briefly reviewing the pathophysiology, clinical features and recommended complementary investigations which are necessary for satisfactory diagnosis and treatment. These vary depending on the characteristics of the bleeding on neuroimaging, age and clinical situation of the patient. We particularly consider the therapeutic aspects, basically of medical treatment but also some aspects of surgical treatment, both during the acute phase of bleeding, when the main objective is to prevent and treat the neurobiological and systemic complications, such as the specific underlying disorder or lesion causing the intracerebral hemorrhage, so as to prevent further bleeding.

General measures, mechanical ventilation, control of blood pressure, the prevention and treatment of raised intracranial pressure and the possibilities of specific medical treatment in reducing the zone of ischemic penumbra are also reviewed. Since surgical treatment is controversial, we have considered the most generally accepted indications for this and the different techniques used. Finally we review the risk factors identified in cerebral hemorrhage which permit primary prevention.