Traumatic ICH - An Interview with Erin D'Agostino, MD

Traumatic intracranial hemorrhage requires a nuanced clinical approach where medical management often serves as the definitive treatment rather than a mere temporizing measure for surgery. Effective management hinges on the Monroe-Kelly hypothesis, which balances intracranial pressure, blood volume, and cerebral perfusion to prevent secondary ischemic injury. Clinicians must distinguish between traumatic and spontaneous etiologies, as their treatment pathways differ significantly. Key strategies include maintaining normotension—specifically avoiding systolic blood pressure below 90 mmHg—and reserving hyperventilation only as a brief bridge to surgical intervention. Risk stratification, such as identifying high-risk radiographic findings or coagulopathy, guides whether patients require transfer to tertiary centers or can be safely monitored. Guest Erin D'Agostino, a neurology resident and co-author of the February 2025 *Emergency Medicine Practice* article, emphasizes that understanding these pathophysiological dynamics is essential for optimizing patient outcomes across all practice settings.