1.
Medhat Mustafa, MD,
Department of Neurosurgery
Suez Canal University, Ismailia, Egypt

2.
Spontaneous intracerebral
Hemorrhage

3.
Objectives

4.
etiology
Sites
Diagnosis
Does it increase
What to do

5.
Etiology
• 1ry
• 2ry

6.
Hypertension
May be or due to microaneuryms

7.
2ry
Aneurysm
AV Malformation
Drugs
Hemorrhage in tumors

8.
Sites

9.
• More in basal ganglia than lobar
33% in first 1-3 hours
16% in 3 – 6 hours
Rebleeding
early

10.
Late rebleeding

11.
How to prevent
Prevention of ICH regrowth: control of
BP
Prevention of ICH regrowth: hemostatic
treatment at acute phase

12.
Although BP management is recommended for
the prevention of SICH, excessive decreases in
BP may induce hypoperfusion/ ischemic
complications in patients with increased ICP.
Several studies have therefore aimed to
determine the appropriate BP level in patients
with SICH.

13.
Hematoma regrowth (re-bleeding) has been
recognized as an important risk factor for early
neurological deterioration and poor outcomes

14.
Injection of activated recombinant factor VII
(rFVIIa) has been suggested as a more
aggressive treatment for the prevention of
hematoma regrowth.

15.
hemostatic therapy with rFVIIa reduced growth
of the hematoma but did not improve survival
or functional outcomes following intracerebral
hemorrhage.

16.
Furthermore, participants undergoing rFVIIa
treatment tended to experience a higher
number of serious, adverse thromboembolic
events.

17.
FVIIa, prothrombin complex concentrate (PCC)
and fresh frozen plasma (FFP) were used as
nonspecific agents

18.
Prediction of hematoma regrowth
Several prospective studies have been suggested
that “spot signs” visualized via computed
tomography (CT) using contrast medium may
serve as crucial predictors of hematoma
regrowth and mortality.

19.
“leakage signs” may also represent
significant predictors of hematoma regrowth.

20.
Diagnosis
Computed tomography
(CT) scan is convenient and
generally used for
emergent diagnosis of
intracerebral hematoma

21.
Diagnosis
magnetic resonance image
(MRI), especially gradient
echo, is very useful with high
sensitivity although MRI is
better for detection of acute
ischemia and chronic
hemorrhage

22.
Treatment

23.
A systematic review and meta-analysis of
ten trials (2,059 patients) in the Cochrane
Database51) concluded that surgical
intervention for supratentorial SICH was
associated with significant improvements in
the rate of death/disability when compared
with conservative management

24.
Although craniotomy is not recommended for
SICH treatment, research suggests that
minimally invasive surgical (MIS) procedures—
such as stereotactic aspiration, endoscopic
aspiration, and navigation surgery—may be both
safe and effective in this patient population.

25.
posterior fossa ICH
patients with ICH >3 cm in diameter have
better outcomes with surgical
decompression

26.
Conclusion