[Treatment of cerebral hemorrhage]

The incidence of cerebral hemorrhage in France is 25000 new cases per year. Their prognosis is especially grim: six months afterward, 30-50% of these patients have died and only 20% are able to live independently. Management of acute forms requires, above all, hospitalization in a specialized neurovascular unit of proven quality. Initial treatment includes general measures to avoid possible early aggravation and the prevention and treatment of some complications. Specific treatment by recombinant factor VII can be effective in the first 4 hours after symptoms begin. A phase III study is under way to confirm its efficacy against hematoma growth in the first 24 hours and prognosis at 3 months. According to the recent STICH study, surgery is indicated in the case of hydrocephaly, for large cerebellar hematomas and for cortical supratentorial hematomas located less than 1 cm from the cortical surface. Beyond these situations, surgery must be considered on a case-by-case basis, until other studies more clearly specify indications and techniques. The pathophysiology of cerebral hemorrhage remains poorly understood but numerous research pathways are being explored and should make it possible to identify new treatment targets to combat, in particular, cerebral edema and neuronal lesions.