價Check for updatesReceived:15 August 2022 Accepted:12 January 2023D0t10.1002/jhm.13051Journal ofCLINICAL GUIDELINE HIGHLIGHTS FORHospital Medicinesh.THE HOSPITALISTClinical guideline highlights for the hospitalist:2022 AmericanHeart Association/American Stroke Association Guideline forthe management of patients with spontaneous intracerebralhemorrhageDesiree C.Burroughs-Ray MD,MPH12 Ariana F.VanDillen MD1Christopher D.Jackson MD1Department of Internal Medicine,Universityof Tennessee Health Sciences CenterGUIDELINE TITLE:2022 Guideline for the Management of Patients withMemphis,Tennessee,USASpontaneous Intracerebral Hemorrhage:A Guideline From the American Heart2Department of Pediatrics.University ofTennessee Health Sciences Center,Memphis,Association/American Stroke AssociationTennessee,USARELEASE DATE:May 2022PRIOR VERSION:Guidelines for the Management of Spontaneous IntracerebralCorrespondenceDesiree C.Burroughs-Ray,MD,MPH,Hemorrhage:A Guideline for Healthcare Professionals from the American HeartDepartment of Intemal Medicine,UniversityAssociation/American Stroke Association 2015of Tennessee Health SciencesCenter (UTHSC),49 N.Dunlap St.MemphisDEVELOPER:American Heart Association and American Stroke AssociationTN38104.U5AFUNDING SOURCE:NoneEmail:dburroug@uthsc.eduTARGET POPULATION:Adult Patients with Spontaneous Intracerebral HemorrhageBACKGROUNDfossa to determine treatment strategies and prognosis (Strongrecommendation,moderate quality of evidence-nonrandomized).Intracerebral hemorrhage (ICH)is a brain injury resulting from acuteAcute computed tomography (CT)angiogram and considerationblood extravasation into the brain parenchyma secondary to cerebralof venography are recommended to evaluate for macrovascularblood vessel rupture.ICH is one of the deadliest forms of acutedisease in the following patients:(1)age <70 years(2)age <45 yearsstroke,with an early mortality rate of 30%-40%.1 The incidence ofand deep/posterior fossa spontaneous ICH,or (3)age 45-70 yearsICH increases with age,placing older individuals on anticoagulants atand deep/posterior fossa without a history of hypertension.1risk for higher mortality rates.The 2022 Guideline for theAdditionally,catheter intra-arterial digital subtraction angiographyManagement of Patients with Spontaneous Intracerebral Hemor-(DSA),the gold standard for evaluating macrovascular disease,shouldrhage provides recommendations on diagnosis,treatment,andbe used in patients with spontaneous IVH and no detectableanticoagulant use in patients experiencing ICH.1 The AHA/ASAparenchymal hemorrhage.Identifying macrovascular lesions such asGuideline provides 124 specific recommendations,of which sevenarteriovenous malformations and aneurysms,which are associatedhave been highlighted as most relevant to practicing hospitalists.with rebleeding.allows for appropriate intervention and preventionof recurrence.Magnetic resonance imaging is beneficial to monitorKEY RECOMMENDATIONS FOR THEfor ongoing disease,including cere
