- ORDER: CT HEAD NONCONTRAST or MRI BRAIN STAT
- Assess the severity intracerebral hemorrhage
- ICH Scale
| Component | ICH Score Points |
| GCS score | |
| 3–4 | 2 |
| 5–12 | 1 |
| 13–15 | 0 |
| ICH volume, cm3 | |
| ≥30 | 1 |
| <30 | 0 |
| IVH | |
| Yes | 1 |
| No | 0 |
| Infratentorial origin of ICH | |
| Yes | 1 |
| No | 0 |
| Age, y | |
| ≥80 | 1 |
| <80 | 0 |
| Total ICH Score | 0–6 |
Level of Blood Pressure Control is Controversial
- 2015 Stroke Guidelines state that patients px with SBP 150-220 and should have SBP acutely lowered to SBP < 140 (if no contraindications)
- Recent ATACH-2 trial 2016 illustrated that reduction SBP < 140 did not result in lower rate of death/disability compared to SBP goal 140-160
- Agents: hydralazine, labetalol, nicardipine
- avoid nitrates due to risk for cerebral vasodilation and cerebral edema
- Correct coagulopathies & stop all anti-coagulants/anti-platelet
- FFP 15-20 mL/kg
- If on Vitamin K Antagonist à PCC and Vitamin K 5 mg or 10 mg IV/PO daily for several days
- Platelets for antiplatelet agents are not indicated (increased mortality).
- If severe coagulation factor deficiencies or thrombocytopenia consider replacement with PCC or platelets
- CTA/MRA once stable, monitor for seizure activity
- Most supratentorial ICH do not need neurosurgical intervention. (ongoing studies)
- Call NSGY if:
- Cerebellar hemorrhage + deteriorating neurologically OR who have brainstem compression &/or hydrocephalus! Need surgical evacuation
- Strongly consider neurosurgical intervention in posterior fossa or temporal lobe hemorrhage > 3 cm
- Patients at risk for cerebral edema and hydrocephalus (see cerebral edema and ICP below)