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Current Neurology and Neuroscience Reports

Published in:

Open Access 01-10-2017 | Stroke (H Diener, Section Editor)

Management of Spontaneous Intracerebral Hemorrhage

Authors: Roland Veltkamp, Jan Purrucker

Published in: Current Neurology and Neuroscience Reports | Issue 10/2017

Abstract

Purpose of Review

We review the current evidence for medical and surgical treatments of spontaneous intracerebral hemorrhage (ICH).

Recent Findings

Therapy with hemostatic agents (e.g. factor VIIa and tranexamic acid) if started early after bleeding onset may reduce hematoma expansion, but their clinical effectiveness has not been shown. Rapid anticoagulation reversal with prothrombin concentrates (PCC) plus vitamin K is the first choice in vitamin K antagonist-related ICH. In ICH related to dabigatran, anticoagulation can be rapidly reversed with idarucizumab. PCC are recommended for ICH related to FXa inhibitors, whereas specific reversal agents are not yet approved. While awaiting ongoing trials studying minimally invasive approaches or hemicraniectomy, the role of surgery in ICH remains to be defined. Therapies targeting downstream molecular cascades in order to prevent secondary neuronal damage are promising, but the complexity and multi-phased nature of ICH pathophysiology is challenging. Finally, in addition to blood pressure control, antithrombotic prevention after ICH has to consider the risk of recurrent bleeding as well as the risk of ischemic events.

Summary

Treatment of acute ICH remains challenging, and many promising interventions for acute ICH await further evidence from trials.

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Title: Management of Spontaneous Intracerebral Hemorrhage
Authors: Roland Veltkamp
Jan Purrucker
Publication date: 01-10-2017
Publisher: Springer US
Published in: Current Neurology and Neuroscience Reports / Issue 10/2017
Print ISSN: 1528-4042
Electronic ISSN: 1534-6293
DOI: https://doi.org/10.1007/s11910-017-0783-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Management of Spontaneous Intracerebral Hemorrhage

Abstract

Purpose of Review

Recent Findings

Summary

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

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Molecular Imaging and Updated Diagnostic Criteria in Lewy Body Dementias

Neurological Complications of Therapeutic Monoclonal Antibodies: Trends from Oncology to Rheumatology

Carotid Artery Stenosis: Medical Therapy, Surgery, and Stenting

Sensory Neuronopathies

Genetics of Alzheimer’s Disease: the Importance of Polygenic and Epistatic Components

Imaging the Etiology of Apathy, Anxiety, and Depression in Parkinson’s Disease: Implication for Treatment