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Semin Neurol 2005; 25(4): 445-452
DOI: 10.1055/s-2005-923538
Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Treatment and Prevention of Primary Intracerebral Hemorrhage

Amytis Towfighi1 , Steven M. Greenberg1 , Jonathan Rosand1
  • 1Vascular and Critical Care Neurology, Massachusetts General Hospital, Boston, Massachusetts
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Publication History

Publication Date:
08 December 2005 (online)

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ABSTRACT

Intracerebral hemorrhage (ICH), which constitutes 10 to 15% of all strokes and affects ~65,000 people each year in the United States, has the highest mortality rate of all stroke subtypes. Hypertension, cerebral amyloid angiopathy, and anticoagulation underlie the majority of cases of ICH. Warfarin not only increases the risk but also increases the severity of ICH by causing hematoma expansion. With the advent of gradient-echo magnetic resonance imaging, patients with underlying cerebral amyloid angiopathy or hypertensive vasculopathy can be identified, and measures can be taken to prevent ICH. Initiating an antihypertensive regimen in a patient with nonlobar microbleeds suggestive of hypertensive vasculopathy, and withholding warfarin in patients with lobar microbleeds suggestive of cerebral amyloid angiopathy, are emerging prevention strategies. Although a treatment for cerebral amyloid angiopathy does not exist, agents targeting β-amyloid metabolism and bioactivity are promising candidates. Strategies for preventing warfarin-associated hemorrhage include strict monitoring of anticoagulation levels and using agents such as direct thrombin inhibitors. The future of ICH management lies in therapies targeted at the pathophysiological steps in ICH. Potential treatments include glutamate receptor antagonists for preventing glutamate excitotoxicity, matrix metalloproteinase and thrombin inhibitors for preventing perihematomal edema, and recombinant activated factor VII for preventing hematomal expansion.

KEYWORDS

Intracerebral hemorrhage - cerebral amyloid angiopathy - hypertension - warfarin

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