[Spontaneous intracerebral hemorrhage. A disease in transition]

The clinical features of intracerebral hemorrhage have changed during the last 10 to 15 years. There are indications that the predominance in men is related to higher alcohol consumption. Hypertension plays a less important role than formerly; instead, alcoholic hepatic disease, disorders of coagulation, cerebral amyloid angiopathy and, specially in the USA, drug abuse have gained in influence. Long-term anticoagulation therapy still carries a major risk of intracerebral hemorrhage, although this may the less with INR values of 2.0 to 3.0%. The most striking change is a decrease by half of hospital mortality together with less severe initial symptoms. The reasons might be a fall in incidence, successful treatment of high-risk hypertensive patients, diagnosis of small encapsulated hematomas by CT and changes in referral modes.