# Intracerebral Hemorrhage: Advances, Knowledge Gaps, and Future Directions

## TL;DR

This review summarizes recent advances and challenges in treating intracerebral hemorrhage, highlighting gaps in improving patient outcomes and suggesting future research directions.

## Contribution

The paper provides a comprehensive synthesis of current ICH research and identifies emerging strategies for better patient care and future innovation.

## Key findings

- Despite advances in neuroimaging and surgical techniques, functional outcomes for ICH patients remain poor.
- Current trials have not shown significant improvements in ICH treatment outcomes or survival rates.
- The review emphasizes the need for better prehospital and in-hospital management to reduce treatment delays.

## Abstract

Acute spontaneous intracerebral hemorrhage (ICH) remains a severe and challenging cerebrovascular condition, associated with high rates of morbidity and mortality. The pathophysiology of injury following ICH involves mass effect, increased intracranial pressure, hematoma expansion, and toxicity from blood‐breakdown products. Over the past decade, substantial progress has been made in risk stratification, therapeutic strategies, and outcome prognostication. Although case‐fatality rates have declined with advances in neuroimaging, acute care, and surgical techniques, functional outcomes remain poor, with little improvement. Several trials have investigated the optimal medical and surgical treatments for ICH, but none have shown significant improvements in outcomes or survival. This review aims to provide a comprehensive overview of ICH, including its epidemiology, associated costs, pathophysiological mechanisms, and management approaches. Herein, we explored recent advancements in neuroimaging techniques and their roles in diagnosing ICH and predicting patient outcomes. Additionally, we assessed the impact of prehospital and in‐hospital management practices, such as pharmacological and surgical interventions, and discussed the implications of delays before final treatment. By summarizing current research and evidence‐based practices, this review aims to highlight established and emerging strategies for improving outcomes for patients with ICH and identify areas for future research and development in the field.

This review provides a comprehensive synthesis of current research on the epidemiology, pathophysiological mechanisms, imaging characteristics, treatment delays, clinical management strategies, neural repair, and prognostic prediction of intracerebral hemorrhage (ICH). The findings contribute to the development of evidence‐based strategies and innovative approaches aimed at improving patient outcomes, while also offering clear directions for future research in this field.