Intracerebral Haemorrhage

About Intracerebral Haemorrhage

Intracerebral Haemorrhage is a rapid-access clinical decision support tool covering the complete management pathway from CT interpretation through to ward-based care. Built by a Neurology and Stroke Fellow and referenced to RCP 2023, AHA/ASA 2022, INTERACT-2, ATACH-2, ENRICH 2023, and ANNEXA-1.

~40% 30-day mortality. Haematoma expansion occurs in 30–38% within 24 hours and doubles 30-day mortality. Rapid BP lowering and anticoagulation reversal are the two most effective interventions.

8-STEP MANAGEMENT PATHWAY:

Step 1: CT Interpretation
- ABC/2 volume calculator
- CT expansion signs — spot sign, swirl sign, island sign, blend sign
- Haematoma location and aetiology

Step 2: ICH Score Calculator
- Interactive calculator — GCS, volume, IVH, origin, age
- 30-day mortality estimate
- Prognostic guidance — do not use as sole basis for withdrawal

Step 3: Blood Pressure Management
- Target SBP <140 mmHg within 1 hour — INTERACT-2, ATACH-2
- IV antihypertensive drug table — labetalol, nicardipine, GTN
- BP assessment tool

Step 4: Anticoagulation Reversal
- Warfarin — vitamin K, PCC
- DOAC reversal — idarucizumab, andexanet alfa
- Heparin — protamine sulphate

Step 5: Surgical Decision-Making
- ENRICH 2023 criteria — minimally invasive surgery
- Cerebellar ICH criteria
- STICH II evidence — EVD indications

Step 6: ICP Management and Herniation
- Herniation protocol
- Mannitol and hypertonic saline
- CPP targets

Step 7: Ward Management
- Monitoring orders, VTE, seizure prophylaxis
- Glucose management, MDT, goals of care

Step 8: Prognosis and Secondary Prevention
- Outcome determinants
- Anticoagulation restart decisions
- Lifelong BP management

FEATURES:
- Interactive calculators: ICH Score, ABC/2 volume, BP assessment
- Every step cites its source guideline; tap to open
- Works fully offline
- One-time purchase; no subscription

For qualified healthcare professionals only. Always verify against local protocols and seek senior neurosurgical input.