Spontane intrazerebrale Blutungen

Spontaneous intracerebral hemorrhage (ICH) is associated with high morbidity and mortality. The most common etiologies are cerebral microangiopathies, particularly arteriolosclerosis and cerebral amyloid angiopathy, more rarely macrovascular or other causes. After decades of limited progress in ICH treatment, there has been a paradigm shift toward recognizing it as an acute emergency requiring immediate intervention. Key components of acute care are encompassed in a “care bundle,” which includes rapid blood pressure normalization (to systolic levels < 140 mm Hg), reversal of potential anticoagulation, and timely evaluation of neurosurgical options (hematoma evacuation, external ventricular drainage or intracranial pressure monitoring), with a particular focus on minimally invasive procedures. Treatment in a stroke unit or specialized intensive care unit may be advantageous. In subsequent management, understanding the underlying cause of the ICH is critical. In most cases, computed tomography (CT) angiography and brain magnetic resonance imaging (MRI) provide important diagnostic insights. Based on the identified cause, individualized secondary prevention strategies can be implemented. This may include stringent blood pressure management, direct treatment of underlying causes (e.g., in case of arteriovenous malformations), and careful evaluation of restarting antithrombotic medications. In the coming years, a large number of studies are expected to further enhance our understanding of ICH, improve acute management strategies, and optimize secondary prevention.