Approximately 500000 new strokes occur yearly in the US. Fifteen per cent of these patients are diagnosed with intracerebral hemorrhage (ICH). Despite development of specialized stroke and neurological intensive care units, overall mortality of ICH patients remains high and patients who survive are often left with profound disabilities. However, new treatment avenues seem to be evolving for this disorder.

In addition to its use as thrombolytic therapy for myocardial infarction, the last 3 years have witnessed a more widespread use of rTPA for the treatment of acute ischemic stroke. Since blood pressure was controlled after rTPA or placebo administration during the NINDS Stroke with an improved rate of hemorrhagic complications in relation to other thrombolytic trials, it seems that uncontrolled hypertension may increase the risk of hemorrhagic transformation or hematoma formation in ischemic brain tissue after thrombolysis. For this reason, the American Heart Association and American Academy of Neurology have provided guidelines for blood pressure control when thrombolytic therapy is used in ischemic stroke victims (Guidelines for thrombolytic therapy, 1996). In this chapter, we will review the epidemiology, physiopathology, pertinent clinical features, complications and the available therapies for non-traumatic, supratentorial ICH as well as current and future avenues of research in this field.

Epidemiology

Spontaneous intracerebral hemorrhage comprises approximately 13% of all stroke types (Broderick et al., 1993). Although significant geographical variability in the incidence of ICH exists, Asian countries have a two- to threefold higher incidence of ICH. Whether the reason for this striking difference in incidence rate resides only in genetic factors is unclear, but environmental factors certainly play an important role. In the United States, ICH affects 37000 persons annually and it has a 30-day mortality rate of 35 to 52%. Only 20% of ICH patients have some degree of functional independence at 6 months (Counsell et al., 1995). Some of the clearly defined risk factors include presence of systemic hypertension, alcohol consumption, hypercholesterolemia, use of anticoagulants, and recreational drug abuse. In the elderly, cerebral amyloid angiopathy (CAA) becomes a prevalent cause of ICH.

Since the 1950s, a consistent fall in mortality due to ICH has been documented worldwide (Broderick et al., 1993).