[Management and predictors in patients with spontaneous intracerebral hemorrhage]

To review about novel aspects in the initial management of patients with spontaneous intracerebral hemorrhage (SICH) and to analyze a group of predictors with influence on the election of certain therapies and on the 30-day mortality.

SICH often constitutes a critical illness. Thus, many SICH patients are admitted in intensive care units (ICUs) for continuous monitoring and 'appropriate' treatment. In these settings it is essential to have predictors of poor outcome to plan the level of care and to optimize resource utilization. Clinical management of these patients focuses on controlling the intracranial pressure, stopping or slowing the hematoma expansion, limiting the secondary injury and preventing medical complications.

The 30-day mortality of SICH remains dismal (42%) despite modern ICUs. Recent prognostic studies have brought new insights about various SICH predictors, but even so there are still several unanswered questions. Treatment for this hemorrhagic stroke is primarily supportive, although recombinant factor VIIa may represent the first proven treatment for SICH.