Modern aspects of the treatment of spontaneous intracerebral hemorrhage (literature review)

Intracerebral hemorrhage (ICH) is the most devastating and disabling type of stroke. Uncontrolled arterial hypertension (AH) is the most common cause of spontaneous ICH. Recent advances in neuroimaging, organized stroke treatment, specialized neuro-intensive care, medication and surgical treatment have improved the management of patients with ICH. Timely respiratory tract protection, control of malignant hypertension, urgent treatment of coagulopathy and surgical intervention can increase the chances of survival in patients with severe ICH. Two recent randomized trials have proven the safety of intensive reduction of systolic blood pressure to <140 mmHg. Platelet transfusion in patients receiving antiplatelet therapy is not indicated unless the patient has planned surgical removal of a hematoma. In patients with a small hematoma without a significant increase in volume, there is no indication for the routine use of mannitol or hypertensive saline solution (HSS). However, for patients with large intracerebral bleeding (volume > 30 cubic centimeters) or symptomatic perihematomic edema, it may be useful to maintain serum sodium levels at 140-150 meq/L for 7-10 days to minimize the expansion of edema and mass effect. Mannitol and HSS can be used in emergency cases with exacerbation of cerebral edema, increased intracranial pressure (ICP) or in the event of a hernia. HSS should be administered through the central channel as a continuous infusion (3%) or bolus (23.4%). Ventriculostomy is indicated in patients with severe intraventricular hemorrhage, hydrocephalus or elevated ICP. Emergency evacuation of a hematoma may be useful for patients with large cerebellar or temporal hematoma