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    Secondary Intracerebral Hemorrhage (sICH) Score

    Quantifies likelihood of underlying vascular etiology in patients with ICH.
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    Advice

    • Bear in mind that the sICH Score is an adjunct to, and not a substitute for, clinical judgment.
    • In a patient with sICH Score <2 and CTA negative for vascular abnormality, catheter angiogram may present greater procedural risks than benefits from identifying an underlying vascular etiology.
    • In selected patients with sICH Score >2 and CTA negative for vascular abnormality, catheter angiogram may be considered after careful weighing of procedural risks and benefits. Note that CTA is not the gold standard but remains a highly sensitive and specific imaging technique for detecting vascular abnormalities.

    Management

    • ICH is a neurological emergency. Immediate neurological and neurosurgical consultation should be obtained on patients with evidence of any ICH on imaging.
    • Hypertensive patients with acute ICH should undergo blood pressure reduction with intravenous agents. The target blood pressure should be discussed with the neurological or neurosurgical consultant.
    • The decision to administer reversal agents (e.g. desmopressin) blood products (e.g. prothrombin factor concentrate, fresh frozen plasma), or anti-epileptic medications should not be made without discussing with the neurological or neurosurgical consultant.
    • Platelet administration is NOT recommended in the setting of antiplatelet-related ICH.

    Critical Actions

    It is crucial to identify and reverse anticoagulant-associated ICH (using agents tailored to the underlying anticoagulant).

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