Thrombosis risk balanced against catastrophic bleeding
Neurosurgical intervention selection
Cerebellar evacuation reduces mortality in selected patients
Supratentorial surgery functional benefit uncertain overall
Minimally invasive approaches evolving and center dependent
Prognostication ethics
Early limitations of care can create self fulfilling prophecy
Delayed prognostication reasonable when uncertainty
Shared decision making and time limited trials
Patient Discharge Instructions
copy discharge instructions
Intracerebral hemorrhage aftercare
Medication safety
No NSAIDs unless explicitly prescribed
No alcohol binges
No illicit stimulants
Blood pressure plan
Home BP monitoring if available
Take BP medications exactly as prescribed
Primary care or stroke clinic follow up within 1 to 2 weeks if discharged
Activity guidance
No driving until cleared
Avoid heavy lifting until cleared
Fall prevention strategies
Return to ED immediately for
New or worsening weakness
New speech trouble
New severe headache
Repeated vomiting
Seizure
Confusion or fainting
Vision loss
Any rapid decline
References
Clinical guidelines and landmark evidence
Core guidelines
AHA ASA guideline for spontaneous intracerebral hemorrhage 2022
Blood pressure acute management recommendations
Antiplatelet and platelet transfusion recommendations
Neurocritical Care Society and Society of Critical Care Medicine guideline for reversal of antithrombotics in intracranial hemorrhage 2016
Warfarin reversal with PCC and vitamin K
DOAC reversal strategies
Key trials and evidence base
INTERACT2 trial intensive BP lowering in acute ICH
Functional outcome signal with SBP target near 140 mmHg
Safety considerations for very low SBP
ATACH II trial intensive BP lowering in acute ICH
No clear functional benefit with very intensive targets
Renal adverse event signal
PATCH trial platelet transfusion in antiplatelet associated ICH
Worse outcomes with platelet transfusion in nonsurgical patients
Avoid routine platelet transfusion
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.