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Updates in managing ICH and SAH

      Hemorrhagic stroke includes non-traumatic intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). Although comprising a minority of stroke cases, ICH and SAH patients are often severely impaired and these disorders contribute an equivalent burden of morbidity and mortality as ischemic stroke. The most common cause of ICH is chronic hypertension, however cerebral amyloid angiopathy, anticoagulant medications, and underlying vascular anomalies account for a significant proportion of cases. Principles of management include urgent clinical and imaging classification, control of extremely elevated blood pressure, reversal of coagulopathy when present, and surgical hematoma evacuation in appropriate patients. Although evidence for optimal ICH treatment has lagged behind ischemic stroke, numerous ICH clinical trials have been performed in the last decade and these have provided useful information regarding potential interventions. Non-traumatic SAH is usually due to a ruptured saccular aneurysm. Principles of management for SAH include early securing of the ruptured aneurysm via endovascular coiling or surgical clipping in order to eliminate risk of re-bleeding, identifying and treating vasospasm and delayed cerebral ischemia, and managing hydrocephalus via cerebrospinal fluid diversion. Guidelines exist for management of ICH and SAH. Both ICH and SAH are considered neurological emergencies and new paradigms such as Emergency Neurological Life Support provide a framework for care and education about these diseases across disciplines.
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