Intracranial Hemorrhage Follow-up

Updated: Dec 07, 2018
  • Author: David S Liebeskind, MD, FAAN, FAHA, FANA; Chief Editor: Helmi L Lutsep, MD  more...
  • Print

Further Outpatient Care

See the list below:

  • After hospital discharge, continued physical, occupational, and speech therapy may be required.

  • Administer medications to control hypertension and to prevent complications such as seizures, urinary tract infections, or venous thromboses.


Further Inpatient Care

Initial management of intracerebral hemorrhage generally is conducted in the ICU. Subsequent care generally includes the following:

  • Serial neurologic examinations

  • Treatment of elevated intracranial pressure

  • Placement of ventricular catheter should hydrocephalus develop

  • Avoidance of hypotension or hypertension (MAP = 70-130 mm Hg)

  • Use of isotonic solutions, such as normal saline, to minimize cerebral edema

  • Treatment with 3 X isotonic saline should hyponatremia due to cerebral salt wasting occur

  • Avoidance of hyperthermia

  • Treatment or prophylaxis of seizures

  • Treatment of urinary tract infections

  • Prevention of venous thrombosis with intermittent compression stockings plus or minus low-dose subcutaneous unfractionated or low molecular weight heparin

  • Prophylaxis for gastric ulcers

  • Physical, occupational, and speech therapy

  • Psychological support with cautious use of sedatives, if necessary

  • Repeat CT scan in case of clinical deterioration


Inpatient & Outpatient Medications

See the list below:

  • Antihypertensives for modification of blood pressure

  • Mannitol or other osmotic diuretics for elevated intracranial pressure

  • Acetaminophen for fever and headache relief

  • Fosphenytoin or other anticonvulsants for posttraumatic seizures

  • Famotidine or other antacids for gastric ulcer prophylaxis

  • Anticholinergics for bladder complications

  • Baclofen, diazepam, or tizanidine for spasticity

  • Amitriptyline, carbamazepine, or gabapentin for neuropathic pain



Following prehospital and emergent stabilization, patients with intracerebral hemorrhage should be transferred to a medical facility with neurosurgical expertise.



See the list below:

  • Early detection and aggressive treatment of hypertension

  • Cautious management of anticoagulation and other antithrombotic medications

  • Careful selection of subjects suitable for thrombolysis

  • Consideration of cerebral amyloid angiopathy as a significant risk factor for intracerebral hemorrhage [17, 18]

  • Public education campaigns emphasizing the dangers of heavy alcohol intake and sympathomimetic use

  • Public education regarding traumatic brain injury, including appropriate use of safety equipment, precautions, and measures that may reduce the incidence of head injury

  • Prevention and management of preterm labor that may reduce intraventricular hemorrhage due to germinal matrix hemorrhage



See the list below:

  • Neurological deficits or death

  • Seizures

  • Hydrocephalus

  • Spasticity

  • Urinary complications

  • Aspiration pneumonia

  • Neuropathic pain

  • Deep venous thrombosis

  • Pulmonary emboli

  • Cerebral herniation



See the list below:

  • Early reduction in the level of consciousness carries an ominous prognosis.

  • The size and location of intracerebral hemorrhage provide useful prognostic information.

    • Larger hematomas have a worse outcome.

    • Lobar hemorrhage has a better outcome than deep hemorrhage.

    • Significant volume of intraventricular blood is a poor prognostic indicator.

  • The presence of hydrocephalus is associated with a poor outcome.

  • Good outcome in medium to large intracerebral hemorrhage can be predicted on admission by neurologic severity, intracerebral hemorrhage location, and fibrinogen levels. [19]


Patient Education

Educate patients regarding the following:

  • Treatment of hypertension

  • Warning signs and symptoms of stroke as well as preventive measures

  • Traumatic brain injury

  • Adverse effects of alcohol and sympathomimetic substances