ICU · Neurocritical care / vascular

Intracerebral Haemorrhage — ICH Score, BP Control & Surgery

Also known as Intracerebral haemorrhage · ICH · Intraparenchymal haemorrhage · Hypertensive haemorrhage · Amyloid angiopathy · ICH score · Haematoma expansion · Spot sign · INTERACT2 · STICH II

Intracerebral haemorrhage (ICH) is the bleeding into the brain parenchyma, most commonly from hypertension (the deep location — basal ganglia, thalamus, pons, cerebellum) or amyloid angiopathy (the lobar location in the elderly). The CT shows a hyperdense lesion. The ICH Score (the GCS, the age over 80, the infratentorial location, the volume over 30 mL, the intraventricular extension) predicts the 30-day mortality. The management: BP control to SBP 140 mmHg (the INTERACT2 trial — safe and improves the functional outcome; the IV labetalol or nicardipine), reverse the anticoagulation rapidly (the PCC for warfarin; the andexanet alfa for the DOAC; the idarucizumab for dabigatran), prevent the haematoma expansion (the spot sign on the CT angiogram predicts the expansion), and surgery (the cerebellar haemorrhage — the urgent evacuation; the supratentorial — the STICH II showed no routine benefit).

Checked against its sources on 13 Oct 2026