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Prognosis

The mortality rate at six months is between 23 and 58%, and almost half of the survivors will live a dependent life (26,40,44). Recurrence rates are between 2.1 and 3.7% per patient per year. The risk of recurrence is much higher when the site of the first hematoma is lobar (indicative of a probable underlying amyloid angiopathy) than when its topography is suggestive of a hypertensive hematoma (2.46 ).

Prospects

Therapeutic possibilities in the current management of ICH are unfortunately very limited. It is however reasonable to remain hopeful on the following domains:
 Prevention is essential and rests on a good control of hypertension -the main risk factor for ICH, and the proper use of antithrombotic drugs.
 Restricting an increase in the volume of the hematoma in the early hours, using hemostatic agents. Up to now, one trial has been conducted using recombinant Factor VIIa, which unfortunately failed to demonstrate any functional benefit (28). A new trial is underway selecting patients with documented active bleeding.
 Controlling the secondary effects of cytotoxic edema. Iron chelators, such as deferoxamine, are promising, as well as some anti-oxidant molecules. Their efficacy in humans remains to be determined.
 Given the toxicity of blood on the brain parenchyma, special attention is given to various techniques for the draining of the hematoma. Except for rare indications, open surgery has not proven beneficial. But it is reasonable to think that the development of minimally invasive techniques (stereotactic or endoscopy), associated with agents to lyse the clot (whose neurotoxicity remains to be determined) are of considerable hope in the treatment of ICH .

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