Innerklinische Versorgung von intrazerebralen Blutungen

Intracerebral hemorrhage (ICH) is a medical emergency with high morbidity and mortality. General and specific therapeutic approaches aim to improve the patient’s outcome.

The objective of this article is to present the current scientific state regarding the in-hospital care of patients with ICH.

This narrative review presents and analyzes the current evidence regarding treatment options for ICH.

The primary focus of acute therapy is to prevent the prognostically unfavorable enlargement of the hematoma. This is associated with specific computed tomographic markers, as well as the initial hematoma volume, the use of anticoagulants, and a shorter time from symptom onset. An elevated blood pressure should be promptly and precisely lowered to a systolic value below 140 mm Hg, and the inhibition of coagulation must be immediately antagonized. This should be constituted into a treatment bundle with optimal adjustment of vital parameters and implementation of basic intensive care measures. Intraventricular hemorrhage can be effectively treated by external ventricular drainage and intraventricular fibrinolysis, with or without additional lumbar drainage. Minimally invasive procedures for hematoma removal have the potential to improve outcomes in lobar ICH. A realistic prognostic assessment forms the basis for informed treatment decisions regarding ICH.

In recent years, the evidence supporting aggressive therapeutic approaches in ICH has become increasingly robust, with reliable results now available regarding the efficacy of individual or combined measures.