Intracerebral and subarachnoid haemorrhage

At a glance

• Haemorrhage causes about 15 to 20% of strokes but a far larger share of stroke deaths. Clinically it can't be told from infarction, so non-contrast CT decides.
• Intracerebral haemorrhage (ICH): about a third of haematomas expand, mostly in the first 3 to 6 hours. Acute care aims to stop expansion: BP lowering to a systolic of about 140, immediate anticoagulant reversal, and the INTERACT3 bundle.
• Subarachnoid haemorrhage (SAH): about 85% are aneurysmal. Secure the aneurysm early, give nimodipine, and watch for rebleeding, hydrocephalus, delayed cerebral ischaemia and hyponatraemia.