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    Intracerebral Hemorrhage Medical Slides

    Generate publication-quality intracerebral hemorrhage lecture slides in 30 seconds. AI-powered content structured for clinical education.

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    Why teach Intracerebral Hemorrhage?

    Intracerebral hemorrhage accounts for 10-15% of all strokes but carries the highest mortality rate of any stroke subtype (40% at 30 days). Hematoma expansion in the first 6 hours is the primary modifiable prognostic factor. The INTERACT2, ATACH-2, and INTERACT3 trials have refined blood pressure targets, while the pivotal PATCH and INCH trials guide anticoagulant reversal decisions.

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    01ICH Etiology: Hypertensive (Basal Ganglia, Thalamus, Pons, Cerebellum), CAA, AVM, and Coagulopathy
    02ICH Score: Components, 30-Day Mortality Prediction, and Prognostic Communication
    03Acute Blood Pressure Management: INTERACT2, ATACH-2, and the <140 mmHg Target
    04Anticoagulant Reversal: Idarucizumab, Andexanet Alfa, 4-Factor PCC, and Vitamin K
    05Hematoma Expansion Prediction: Spot Sign on CTA and Non-Contrast CT Markers
    06Surgical Intervention: STICH, STICH II, and MISTIE III — Who Benefits from Evacuation?
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    Intracerebral Hemorrhage Presentation FAQ

    How should ICH blood pressure management be presented in teaching?

    Present the evolving evidence: INTERACT2 (2013) showed intensive lowering to <140 mmHg SBP was safe with trend toward functional benefit. ATACH-2 (2016) found no additional benefit with target <120 mmHg and increased renal adverse events. Current AHA/ASA recommendation: target SBP 130-150 mmHg within 2 hours for patients presenting with SBP 150-220 mmHg. INTERACT3 (2023) showed that a care bundle including rapid BP lowering improved functional outcomes.

    What anticoagulant reversal protocols should be included?

    Present reversal agents by anticoagulant: warfarin (4-factor PCC 25-50 IU/kg + IV vitamin K 10 mg, target INR <1.4), dabigatran (idarucizumab 5g IV, immediate complete reversal), rivaroxaban/apixaban (andexanet alfa or 4-factor PCC 50 IU/kg if andexanet unavailable). Emphasize the time-critical nature: reversal should be administered within 60 minutes of presentation. Reference the ANNEXA-4 trial for andexanet alfa and the RE-VERSE AD trial for idarucizumab.

    How should surgical evacuation indications be taught for ICH?

    Present the evidence hierarchy: STICH (2005) showed no benefit of early surgery for supratentorial ICH overall. STICH II (2013) found no benefit for superficial lobar ICH. MISTIE III (2019) showed that minimally invasive catheter-based evacuation to <15 mL residual improved functional outcomes but not mortality. Cerebellar hemorrhage >3 cm with brainstem compression remains a Class I surgical indication. Frame surgery as an evolving field with minimally invasive approaches showing the most promise.

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