Intracerebral Hemorrhage

HTN with sudden focal deficit + vomiting → CT first, never lytics.

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◆Approach

•Reverse anticoagulation per agent (warfarin → 4F-PCC + vit K; dabigatran → idarucizumab; FXa inhibitors → andexanet/4F-PCC; heparin → protamine)
•Target systolic 140 in spontaneous ICH
•ICP management: HOB 30°, mannitol/hypertonic saline, sedation
•Surgical evacuation if cerebellar bleed >3 cm or worsening
•Avoid prophylactic anticonvulsants unless seizure occurs

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