Management of Intracerebral Hemorrhage

NewsGuard 100/100 Score

Intracerebral hemorrhage (ICH) is a type of stroke caused by sudden bleeding in the brain. Only approximately 15% of strokes are due to ICH, but it is one of the most disabling types of strokes to suffer from, with a high rate of morbidity and mortality. Roughly one third of patients experiencing ICH will not survive, and only 20% regain their independence and function.

MRI scan cerebral hemorrhage

Early management

Initial management of ICH involves securing the patient’s airway to restore their ability to breathe and assessing blood pressure and intracranial pressure. Patients may be intubated, particularly if they have lost consciousness or have signs of brainstem herniation. Therapy to lower intracranial pressure is given.

If patients have been treated with thrombolytic, antiplatelet, or anticoagulant medications, those should be reversed. If intracranial pressure is elevated, sedatives, vasopressors such as dopamine and phenylephrine, or antihypertensive drugs can be used to lower it. If those fail, osmotic agents and hyperventilation are the next options. A barbiturate coma is a last resort for patients who don’t respond to ordinary measures.


There is a high risk of seizures following ICH. A seizure may even be the first symptom of ICH. The Stroke Council of the American Heart Association recommends prophylactic treatment with antiepileptic drugs for one month in patients with ICH. Seizures can be managed on an acute basis with intravenous anticonvulsant drugs.


If a fever occurs after ICH, it should be treated with medication and cooling blankets. Fever is associated with a poor outcome in ICH. Laboratory tests, physical exam, and imaging should be used to find the source of infection.

Deep vein thrombosis

Patients with ICH are at risk of deep vein thrombosis (DVT) due to an immobilized state. They should be treated with pneumatic compression devices and elastic stockings to prevent a DVT.


Surgical evacuation of the hematoma is an option for some patients. The procedure can be carried out by craniotomy, burr hole, endoscopy, or stereotaxy. However, studies have not revealed a benefit compared to conservative management.

ICH in children

While no specific management guidelines are available for children, adult guidelines are applicable to children, including fluid management and reduction of fevers.

Pregnant women

There are also no guidelines for management of ICH during pregnancy. Diagnosis can be difficult, as MRI is usually not recommended during pregnancy. However, a complete workup, including brain CT, MRI, transthoracic ultrasound, and vascular ultrasound is recommended if warranted by the risk-benefit ratio.

Many of the drugs commonly used to reduce elevated intracranial pressure have risks for the fetus, but the survival benefit may ultimately outweigh the risks in some cases. Hemodynamic parameters must be monitored carefully in both the mother and fetus. If near term, caesarean delivery is recommended prior to attempted surgical management of vascular malformation.


  1. Management of intracerebral hemorrhage,
  2. Hemorrhagic stroke in children,
  3. Pregnancy and stroke risk in women,

Further Reading

Last Updated: Feb 26, 2019

Dr. Catherine Shaffer

Written by

Dr. Catherine Shaffer

Catherine Shaffer is a freelance science and health writer from Michigan. She has written for a wide variety of trade and consumer publications on life sciences topics, particularly in the area of drug discovery and development. She holds a Ph.D. in Biological Chemistry and began her career as a laboratory researcher before transitioning to science writing. She also writes and publishes fiction, and in her free time enjoys yoga, biking, and taking care of her pets.


Please use one of the following formats to cite this article in your essay, paper or report:

  • APA

    Shaffer, Catherine. (2019, February 26). Management of Intracerebral Hemorrhage. News-Medical. Retrieved on June 12, 2024 from

  • MLA

    Shaffer, Catherine. "Management of Intracerebral Hemorrhage". News-Medical. 12 June 2024. <>.

  • Chicago

    Shaffer, Catherine. "Management of Intracerebral Hemorrhage". News-Medical. (accessed June 12, 2024).

  • Harvard

    Shaffer, Catherine. 2019. Management of Intracerebral Hemorrhage. News-Medical, viewed 12 June 2024,


The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
Post a new comment

While we only use edited and approved content for Azthena answers, it may on occasions provide incorrect responses. Please confirm any data provided with the related suppliers or authors. We do not provide medical advice, if you search for medical information you must always consult a medical professional before acting on any information provided.

Your questions, but not your email details will be shared with OpenAI and retained for 30 days in accordance with their privacy principles.

Please do not ask questions that use sensitive or confidential information.

Read the full Terms & Conditions.

You might also like...
Does long-term, daily low-dose aspirin treatment affect the incidence of stroke or intracerebral bleeding?