🧠 Acute Spontaneous Intracerebral Hemorrhage (ICH) Management
From systolic pressure, anticoagulation relation and surgical indication, give the BP target, anticoagulation-reversal and neurosurgical direction for spontaneous ICH. Instant, browser-side.
Acute Spontaneous Intracerebral Hemorrhage (ICH) Management
Systolic blood pressure (SBP) (mmHg)
Anticoagulation-related
Cerebellar hemorrhage > 3 cm / brainstem compression / hydrocephalus / mass effect with herniation
When to use
Initial management framing of acute spontaneous intracerebral hemorrhage.
How it works
SBP 150–220 → smoothly lower to a target of 140 (maintain 130–150, avoid < 130); SBP > 220 → continuous IV antihypertensive with close monitoring. Anticoagulation-related → stop and reverse at once. Cerebellar hemorrhage > 3 cm / brainstem compression / hydrocephalus / herniation → emergency neurosurgery.
Key points
- Start BP control within 2 h and reach target within 1 h, avoiding large fluctuations; do not lower SBP below 130 (harmful).
- Reverse anticoagulation without waiting for labs — agent-specific (VKA: vitamin K + 4F-PCC; dabigatran: idarucizumab; Xa inhibitor: andexanet or 4F-PCC; heparin: protamine); do not routinely transfuse platelets.
- Cerebellar hemorrhage > 3 cm or with brainstem compression/hydrocephalus needs urgent posterior-fossa decompression/EVD.
- Antiseizure drugs only for clinical seizures (not prophylactic); intermittent pneumatic compression for early VTE prophylaxis.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.