Episode 103: Basic intracranial hemorrhage

Intracranial hemorrhage (ICH) management requires a nuanced, patient-specific approach focused on preventing hematoma expansion and secondary complications. While clinical workflows vary by institution, initial management centers on stabilizing blood pressure—often targeting systolic levels below 140–150 mmHg—and timely reversal of anticoagulation, particularly for patients on direct oral anticoagulants. Monitoring protocols utilize serial neurological exams, such as the NIH Stroke Scale, and interval CT imaging to detect early deterioration. Although most small, stable bleeds require minimal intervention, ICU admission remains standard for close observation of potential edema or neurological decline. Determining the underlying etiology through MRI is essential for long-term risk stratification, even when findings do not immediately alter acute management. Ultimately, the primary goal is identifying the small subset of patients at risk for catastrophic worsening while avoiding unnecessary, resource-intensive care for those with stable, minor hemorrhages.