Intracranial hemorrhage

Management

• SBP <140-160 initially
• For increased ICP: mannitol, hypertonic saline, raise head of bed, ensure normothermia and normoglycemia
• Consult Neurosurgery
• For seizures, may not need to manage if first one is self-limited
• Reverse anticoagulations
  • Warfarin: vitamin K, PCC
  • Rivaroxaban and apixaban: andexanet alfa
  • LMWH/UFH: protamine
  • Dabigatran: idarucizumab
• Intermittent pneumatic compression stockings for VTE prophylaxis
• Repeat imaging in 24 hours

Prevention

• Manage risk factors, especially hypertension (target BP <130/80 based on SPS3 trial)
• Lower alcohol intake, smoking cessation
• Improve diet, increase physical activity, lower sodium intake
• For cerebral amyloid angiopathy, diagnose with the modified Boston criteria and refer to Neurology
  • Treating hypertension still helpful
• No need for statin unless otherwise indicated