J Korean Neurosurg Soc.  2014 Sep;56(3):175-187. 10.3340/jkns.2014.56.3.175.

Clinical Practice Guidelines for the Medical and Surgical Management of Primary Intracerebral Hemorrhage in Korea

• Kim JE
• Ko SB
• Kang HS
• Seo DH
• Park SQ
• Sheen SH
• Park HS
• Kang SD
• Kim JM
• Oh CW
• Hong KS
• Yu KH
• Heo JH
• Kwon SU
• Bae HJ
• Lee BC
• Yoon BW
• Park IS
• Rha JH

• KMID: 2339954
• DOI: http://doi.org/10.3340/jkns.2014.56.3.175

Abstract

The purpose of this clinical practice guideline (CPG) is to provide current and comprehensive recommendations for the medical and surgical management of primary intracerebral hemorrhage (ICH). Since the release of the first Korean CPGs for stroke, evidence has been accumulated in the management of ICH, such as intracranial pressure control and minimally invasive surgery, and it needs to be reflected in the updated version. The Quality Control Committee at the Korean Society of cerebrovascular Surgeons and the Writing Group at the Clinical Research Center for Stroke (CRCS) systematically reviewed relevant literature and major published guidelines between June 2007 and June 2013. Based on the published evidence, recommendations were synthesized, and the level of evidence and the grade of the recommendation were determined using the methods adapted from CRCS. A draft guideline was scrutinized by expert peer reviewers and also discussed at an expert consensus meeting until final agreement was achieved. CPGs based on scientific evidence are presented for the medical and surgical management of patients presenting with primary ICH. This CPG describes the current pertinent recommendations and suggests Korean recommendations for the medical and surgical management of a patient with primary ICH.

Keyword

Clinical; Guideline; Treatment; Spontaneous; Intracerebral hemorrhage

MeSH Terms

Cerebral Hemorrhage*
Consensus
Humans
Intracranial Pressure
Korea
Peer Review
Quality Control
Stroke
Surgical Procedures, Minimally Invasive
Writing

Reference

1. Alberti A, Paciaroni M, Caso V, Venti M, Palmerini F, Agnelli G. Early seizures in patients with acute stroke: frequency, predictive factors, and effect on clinical outcome. Vasc Health Risk Manag. 2008; 4:715–720. PMID: 18827922.

2. Anderson CS, Heeley E, Huang Y, Wang J, Stapf C, Delcourt C, et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013; 368:2355–2365. PMID: 23713578.

3. Anderson CS, Huang Y, Wang JG, Arima H, Neal B, Peng B, et al. Intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT): a randomised pilot trial. Lancet Neurol. 2008; 7:391–399. PMID: 18396107.

4. Andrews BT, Chiles BW 3rd, Olsen WL, Pitts LH. The effect of intracerebral hematoma location on the risk of brain-stem compression and on clinical outcome. J Neurosurg. 1988; 69:518–522. PMID: 3418383.

5. Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) investigators. Antihypertensive treatment of acute cerebral hemorrhage. Crit Care Med. 2010; 38:637–648. PMID: 19770736.

6. Auer LM, Deinsberger W, Niederkorn K, Gell G, Kleinert R, Schneider G, et al. Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma : a randomized study. J Neurosurg. 1989; 70:530–535. PMID: 2926492.

7. Bhattathiri PS, Gregson B, Prasad KS, Mendelow AD;. STICH Investigators. Intraventricular hemorrhage and hydrocephalus after spontaneous intracerebral hemorrhage: results from the STICH trial. Acta Neurochir Suppl. 2006; 96:65–68. PMID: 16671427.

8. Brain Trauma Foundation. American Association of Neurological Surgeons. Congress of Neurological Surgeons. Joint Section on Neurotrauma and Critical Care, AANS/CNS. Bratton SL, Chestnut RM, et al. Guidelines for the management of severe traumatic brain injury. VIII. Intracranial pressure thresholds. J Neurotrauma. 2007; 24(Suppl 1):S55–S58. PMID: 17511546.

9. Brain Trauma Foundation. American Association of Neurological Surgeons. Congress of Neurological Surgeons. Joint Section on Neurotrauma and Critical Care, AANS/CNS. Bratton SL, et al. Guidelines for the management of severe traumatic brain injury. IX. Cerebral perfusion thresholds. J Neurotrauma. 2007; 24(Suppl 1):S59–S64. PMID: 17511547.

10. Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke. 2007; 38:2001–2023. PMID: 17478736.

11. Broderick JP, Adams HP Jr, Barsan W, Feinberg W, Feldmann E, Grotta J, et al. Guidelines for the management of spontaneous intracerebral hemorrhage : a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 1999; 30:905–915. PMID: 10187901.

12. Broderick JP, Brott T, Zuccarello M. Management of intracerebral hemorrhage. In : Batjer HH, editor. Cerebrovascular Disease. Philadelphia, PA: Lippincott-Raven;1997. p. 611–627.

13. Brott T, Reed RL. Intensive care for acute stroke in the community hospital setting. The first 24 hours. Stroke. 1989; 20:694–697. PMID: 2718211.

14. Butcher KS, Jeerakathil T, Hill M, Demchuk AM, Dowlatshahi D, Coutts SB, et al. The Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial. Stroke. 2013; 44:620–626. PMID: 23391776.

15. Cho DY, Chen CC, Chang CS, Lee WY, Tso M. Endoscopic surgery for spontaneous basal ganglia hemorrhage : comparing endoscopic surgery, stereotactic aspiration, and craniotomy in noncomatose patients. Surg Neurol. 2006; 65:547–555. discussion 555-556. PMID: 16720167.

16. Claassen J, Jetté N, Chum F, Green R, Schmidt M, Choi H, et al. Electrographic seizures and periodic discharges after intracerebral hemorrhage. Neurology. 2007; 69:1356–1365. PMID: 17893296.

17. Clarke JL, Johnston SC, Farrant M, Bernstein R, Tong D, Hemphill JC 3rd. External validation of the ICH score. Neurocrit Care. 2004; 1:53–60. PMID: 16174898.

18. Da Pian R, Bazzan A, Pasqualin A. Surgical versus medical treatment of spontaneous posterior fossa haematomas: a cooperative study on 205 cases. Neurol Res. 1984; 6:145–151. PMID: 6151139.

19. De Herdt V, Dumont F, Hénon H, Derambure P, Vonck K, Leys D, et al. Early seizures in intracerebral hemorrhage : incidence, associated factors, and outcome. Neurology. 2011; 77:1794–1800. PMID: 21975203.

20. Engelhard HH, Andrews CO, Slavin KV, Charbel FT. Current management of intraventricular hemorrhage. Surg Neurol. 2003; 60:15–21. discussion 21-22. PMID: 12865003.

21. Fountas KN, Kapsalaki EZ, Parish DC, Smith B, Smisson HF, Johnston KW, et al. Intraventricular administration of rt-PA in patients with intraventricular hemorrhage. South Med J. 2005; 98:767–773. PMID: 16144170.

22. Gilad R, Boaz M, Dabby R, Sadeh M, Lampl Y. Are post intracerebral hemorrhage seizures prevented by anti-epileptic treatment? Epilepsy Res. 2011; 95:227–231. PMID: 21632213.

23. Gregson BA, Broderick JP, Auer LM, Batjer H, Chen XC, Juvela S, et al. Individual patient data subgroup meta-analysis of surgery for spontaneous supratentorial intracerebral hemorrhage. Stroke. 2012; 43:1496–1504. PMID: 22511006.

24. Guyot LL, Dowling C, Diaz FG, Michael DB. Cerebral monitoring devices : analysis of complications. Acta Neurochir Suppl. 1998; 71:47–49. PMID: 9779141.

25. Hallevi H, Albright KC, Aronowski J, Barreto AD, Martin-Schild S, Khaja AM, et al. Intraventricular hemorrhage : Anatomic relationships and clinical implications. Neurology. 2008; 70:848–852. PMID: 18332342.

26. Hattori N, Katayama Y, Maya Y, Gatherer A. Impact of stereotactic hematoma evacuation on activities of daily living during the chronic period following spontaneous putaminal hemorrhage : a randomized study. J Neurosurg. 2004; 101:417–420. PMID: 15352598.

27. Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score : a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001; 32:891–897. PMID: 11283388.

28. Hemphill JC 3rd, Farrant M, Neill TA Jr. Prospective validation of the ICH Score for 12-month functional outcome. Neurology. 2009; 73:1088–1094. PMID: 19726752.

29. Huttner HB, Köhrmann M, Berger C, Georgiadis D, Schwab S. Influence of intraventricular hemorrhage and occlusive hydrocephalus on the long-term outcome of treated patients with basal ganglia hemorrhage : a case-control study. J Neurosurg. 2006; 105:412–417. PMID: 16961136.

30. Juvela S, Heiskanen O, Poranen A, Valtonen S, Kuurne T, Kaste M, et al. The treatment of spontaneous intracerebral hemorrhage. A prospective randomized trial of surgical and conservative treatment. J Neurosurg. 1989; 70:755–758. PMID: 2651586.

31. Kamel H, Navi BB, Nakagawa K, Hemphill JC 3rd, Ko NU. Hypertonic saline versus mannitol for the treatment of elevated intracranial pressure : a meta-analysis of randomized clinical trials. Crit Care Med. 2011; 39:554–559. PMID: 21242790.

32. Kanaya H, Kuroda K. Development in neurosurgical approaches to hypertensive intracerebral hemorrhage in Japan. In : Kaufman HH, editor. Intracerebral hematomas. New York, NY: Raven Press;1992. p. 197–210.

33. Kanaya H, Saiki I, Ohuchi T. Update on surgical treatment. In : Mizukami M, Kanaya K, Yamori Y, editors. Hypertensive Intracerebral Hemorrhage. New York, NY: Raven Press;1983. p. 147–163.

34. Kaneko M, Tanaka K, Shimada T, Sato K, Uemura K. Long-term evaluation of ultra-early operation for hypertensive intracerebral hemorrhage in 100 cases. J Neurosurg. 1983; 58:838–842. PMID: 6854376.

35. Kanno T, Sano H, Shinomiya Y, Katada K, Nagata J, Hoshino M, et al. Role of surgery in hypertensive intracerebral hematoma. A comparative study of 305 nonsurgical and 154 surgical cases. J Neurosurg. 1984; 61:1091–1099. PMID: 6502238.

36. Kase C. Cerebellar hemorrhage. In : Kase C, Caplan L, editors. Intracerebral Hemorrhage. Boston: Butterworth-Heinemann;1994. p. 425–443.

37. Kaufman HH. Stereotactic aspiration with fibrinolytic and mechanical assistance. In : Kaufman HH, editor. Intracerebral Hematoma. New York, NY: Raven Press;1992. p. 182–185.

38. Kazui S, Minematsu K, Yamamoto H, Sawada T, Yamaguchi T. Predisposing factors to enlargement of spontaneous intracerebral hematoma. Stroke. 1997; 28:2370–2375. PMID: 9412616.

39. Kiening KL, Härtl R, Unterberg AW, Schneider GH, Bardt T, Lanksch WR. Brain tissue pO2-monitoring in comatose patients : implications for therapy. Neurol Res. 1997; 19:233–240. PMID: 9192372.

40. Kirollos RW, Tyagi AK, Ross SA, van Hille PT, Marks PV. Management of spontaneous cerebellar hematomas : a prospective treatment protocol. Neurosurgery. 2001; 49:1378–1386. discussion 1386-1387. PMID: 11846937.

41. Ko SB, Choi HA, Parikh G, Helbok R, Schmidt JM, Lee K, et al. Multimodality monitoring for cerebral perfusion pressure optimization in comatose patients with intracerebral hemorrhage. Stroke. 2011; 42:3087–3092. PMID: 21852615.

42. Kollmar R, Staykov D, DÖrfler A, Schellinger PD, Schwab S, Bardutzky J. Hypothermia reduces perihemorrhagic edema after intracerebral hemorrhage. Stroke. 2010; 41:1684–1689. PMID: 20616317.

43. Lapointe M, Haines S. Fibrinolytic therapy for intraventricular hemorrhage in adults. Cochrane Database Syst Rev. 2002; (3):CD003692. PMID: 12137707.

44. Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet. 2005; 365:387–397. PMID: 15680453.

45. Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet. 2013; 382:397–408. PMID: 23726393.

46. Messé SR, Sansing LH, Cucchiara BL, Herman ST, Lyden PD, Kasner SE, et al. Prophylactic antiepileptic drug use is associated with poor outcome following ICH. Neurocrit Care. 2009; 11:38–44. PMID: 19319701.

47. Mokri B. The Monro-Kellie hypothesis : applications in CSF volume depletion. Neurology. 2001; 56:1746–1748. PMID: 11425944.

48. Morgan T, Awad I, Keyl P, Lane K, Hanley D. Preliminary report of the clot lysis evaluating accelerated resolution of intraventricular hemorrhage (CLEAR-IVH) clinical trial. Acta Neurochir Suppl. 2008; 105:217–220. PMID: 19066112.

49. Morgan T, Zuccarello M, Narayan R, Keyl P, Lane K, Hanley D. Preliminary findings of the minimally-invasive surgery plus rtPA for intracerebral hemorrhage evacuation (MISTIE) clinical trial. Acta Neurochir Suppl. 2008; 105:147–151. PMID: 19066101.

50. Morgenstern LB, Demchuk AM, Kim DH, Frankowski RF, Grotta JC. Rebleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemorrhage. Neurology. 2001; 56:1294–1299. PMID: 11376176.

51. Morgenstern LB, Frankowski RF, Shedden P, Pasteur W, Grotta JC. Surgical treatment for intracerebral hemorrhage (STICH): a single-center, randomized clinical trial. Neurology. 1998; 51:1359–1363. PMID: 9818860.

52. Morgenstern LB, Hemphill JC 3rd, Anderson C, Becker K, Broderick JP, Connolly ES Jr, et al. Guidelines for the management of spontaneous intracerebral hemorrhage : a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2010; 41:2108–2129. PMID: 20651276.

53. Morioka J, Fujii M, Kato S, Fujisawa H, Akimura T, Suzuki M, et al. Surgery for spontaneous intracerebral hemorrhage has greater remedial value than conservative therapy. Surg Neurol. 2006; 65:67–72. discussion 72-73. PMID: 16378863.

54. Mould WA, Carhuapoma JR, Muschelli J, Lane K, Morgan TC, McBee NA, et al. Minimally invasive surgery plus recombinant tissue-type plasminogen activator for intracerebral hemorrhage evacuation decreases perihematomal edema. Stroke. 2013; 44:627–634. PMID: 23391763.

55. Murry KR, Rhoney DH, Coplin WM. Urokinase in the treatment of intraventricular hemorrhage. Ann Pharmacother. 1998; 32:256–258. PMID: 9496412.

56. Naff NJ, Hanley DF, Keyl PM, Tuhrim S, Kraut M, Bederson J, et al. Intraventricular thrombolysis speeds blood clot resolution : results of a pilot, prospective, randomized, double-blind, controlled trial. Neurosurgery. 2004; 54:577–583. discussion 583-584. PMID: 15028130.

57. Narayan RK, Kishore PR, Becker DP, Ward JD, Enas GG, Greenberg RP, et al. Intracranial pressure : to monitor or not to monitor? A review of our experience with severe head injury. J Neurosurg. 1982; 56:650–659. PMID: 7069477.

58. Nieuwkamp DJ, de Gans K, Rinkel GJ, Algra A. Treatment and outcome of severe intraventricular extension in patients with subarachnoid or intracerebral hemorrhage : a systematic review of the literature. J Neurol. 2000; 247:117–121. PMID: 10751114.

59. Niizuma H, Shimizu Y, Yonemitsu T, Nakasato N, Suzuki J. Results of stereotactic aspiration in 175 cases of putaminal hemorrhage. Neurosurgery. 1989; 24:814–819. PMID: 2664544.

60. Niizuma H, Yonemitsu T, Jokura H, Nakasato N, Suzuki J, Yoshimoto T. Stereotactic aspiration of thalamic hematoma. Overall results of 75 aspirated and 70 nonaspirated cases. Stereotact Funct Neurosurg. 1990; 54-55:438–444. PMID: 2080362.

61. Nordström CH, Reinstrup P, Xu W, Gärdenfors A, Ungerstedt U. Assessment of the lower limit for cerebral perfusion pressure in severe head injuries by bedside monitoring of regional energy metabolism. Anesthesiology. 2003; 98:809–814. PMID: 12657839.

62. Pantazis G, Tsitsopoulos P, Mihas C, Katsiva V, Stavrianos V, Zymaris S. Early surgical treatment vs conservative management for spontaneous supratentorial intracerebral hematomas : a prospective randomized study. Surg Neurol. 2006; 66:492–501. discussion 501-502. PMID: 17084196.

63. Passero S, Rocchi R, Rossi S, Ulivelli M, Vatti G. Seizures after spontaneous supratentorial intracerebral hemorrhage. Epilepsia. 2002; 43:1175–1180. PMID: 12366733.

64. Qureshi AI, Geocadin RG, Suarez JI, Ulatowski JA. Long-term outcome after medical reversal of transtentorial herniation in patients with supratentorial mass lesions. Crit Care Med. 2000; 28:1556–1564. PMID: 10834711.

65. Qureshi AI, Palesch YY. Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) II: design, methods, and rationale. Neurocrit Care. 2011; 15:559–576. PMID: 21626077.

66. Robertson CS, Valadka AB, Hannay HJ, Contant CF, Gopinath SP, Cormio M, et al. Prevention of secondary ischemic insults after severe head injury. Crit Care Med. 1999; 27:2086–2095. PMID: 10548187.

67. Schreckinger M, Marion DW. Contemporary management of traumatic intracranial hypertension : is there a role for therapeutic hypothermia? Neurocrit Care. 2009; 11:427–436. PMID: 19644773.

68. Steiner T, Kaste M, Forsting M, Mendelow D, Kwiecinski H, Szikora I, et al. Recommendations for the management of intracranial haemorrhage - part I : spontaneous intracerebral haemorrhage. The European Stroke Initiative Writing Committee and the Writing Committee for the EUSI Executive Committee. Cerebrovasc Dis. 2006; 22:294–316. PMID: 16926557.

69. Sypert G, Arpin-Sypert E. Spontaneous posterior fossa hematomas. In : Kaufman H, editor. Intracerebral Hematomas. New York, NY: Raven Press;1992. p. 187–196.

70. Tan SH, Ng PY, Yeo TT, Wong SH, Ong PL, Venketasubramanian N. Hypertensive basal ganglia hemorrhage : a prospective study comparing surgical and nonsurgical management. Surg Neurol. 2001; 56:287–292. discussion 292-293. PMID: 11749988.

71. Teernstra OP, Evers SM, Kessels AH. Meta analyses in treatment of spontaneous supratentorial intracerebral haematoma. Acta Neurochir (Wien). 2006; 148:521–528. discussion 528. PMID: 16467963.

72. Teernstra OP, Evers SM, Lodder J, Leffers P, Franke CL, Blaauw G, et al. Stereotactic treatment of intracerebral hematoma by means of a plasminogen activator : a multicenter randomized controlled trial (SICHPA). Stroke. 2003; 34:968–974. PMID: 12649510.

73. van Loon J, Van Calenbergh F, Goffin J, Plets C. Controversies in the management of spontaneous cerebellar haemorrhage. A consecutive series of 49 cases and review of the literature. Acta Neurochir (Wien). 1993; 122:187–193. PMID: 8372706.

74. Vespa P, McArthur D, Miller C, O'Phelan K, Frazee J, Kidwell C, et al. Frameless stereotactic aspiration and thrombolysis of deep intracerebral hemorrhage is associated with reduction of hemorrhage volume and neurological improvement. Neurocrit Care. 2005; 2:274–281. PMID: 16159075.

75. Vespa PM, O'Phelan K, Shah M, Mirabelli J, Starkman S, Kidwell C, et al. Acute seizures after intracerebral hemorrhage : a factor in progressive midline shift and outcome. Neurology. 2003; 60:1441–1446. PMID: 12743228.

76. Wang WZ, Jiang B, Liu HM, Li D, Lu CZ, Zhao YD, et al. Minimally invasive craniopuncture therapy vs conservative treatment for spontaneous intracerebral hemorrhage results from a randomized clinical trial in China. Int J Stroke. 2009; 4:11–16. PMID: 19236490.

77. Woo KM, Yang SY, Cho KT. Seizures after spontaneous intracerebral hemorrhage. J Korean Neurosurg Soc. 2012; 52:312–319. PMID: 23133718.

78. Zhou X, Chen J, Li Q, Ren G, Yao G, Liu M, et al. Minimally invasive surgery for spontaneous supratentorial intracerebral hemorrhage : a meta-analysis of randomized controlled trials. Stroke. 2012; 43:2923–2930. PMID: 22989500.

79. Ziai WC, Torbey MT, Naff NJ, Williams MA, Bullock R, Marmarou A, et al. Frequency of sustained intracranial pressure elevation during treatment of severe intraventricular hemorrhage. Cerebrovasc Dis. 2009; 27:403–410. PMID: 19295201.

80. Zuccarello M, Brott T, Derex L, Kothari R, Sauerbeck L, Tew J, et al. Early surgical treatment for supratentorial intracerebral hemorrhage : a randomized feasibility study. Stroke. 1999; 30:1833–1839. PMID: 10471432.