Intracerebral Hemorrhage: Advances, Knowledge Gaps, and Future Directions

Acute spontaneous intracerebral hemorrhage (ICH) remains a severe and challenging cerebrovascular condition, associated with high rates of morbidity and mortality. The pathophysiology of injury following ICH involves mass effect, increased intracranial pressure, hematoma expansion, and toxicity from blood-breakdown products. Over the past decade, substantial progress has been made in risk stratification, therapeutic strategies, and outcome prognostication. Although case-fatality rates have declined with advances in neuroimaging, acute care, and surgical techniques, functional outcomes remain poor, with little improvement. Several trials have investigated the optimal medical and surgical treatments for ICH, but none have shown significant improvements in outcomes or survival. This review aims to provide a comprehensive overview of ICH, including its epidemiology, associated costs, pathophysiological mechanisms, and management approaches. Herein, we explored recent advancements in neuroimaging techniques and their roles in diagnosing ICH and predicting patient outcomes. Additionally, we assessed the impact of prehospital and in-hospital management practices, such as pharmacological and surgical interventions, and discussed the implications of delays before final treatment. By summarizing current research and evidence-based practices, this review aims to highlight established and emerging strategies for improving outcomes for patients with ICH and identify areas for future research and development in the field.