Patient handout

Intracerebral Hemorrhage — Deep (hypertensive)

PRODUCTION

1. Your condition

This handout is for intracerebral hemorrhage — deep (hypertensive). Your care team identified this based on: non-contrast ct head showing deep (basal ganglia / thalamus / pons) intraparenchymal blood (aha/asa 2022 pmid 35579034).

Other reasons your team may use this plan: sudden contralateral hemiparesis + sensory loss (putamen/thalamus) or quadriparesis + cn deficits (pons) (aha/asa 2022); long-standing or uncontrolled hypertension (deep ich mechanism); on vka / doac / heparin at presentation (annexa-i pmid 38749032; inch pmid 27302126).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
nicardipine	5 mg/h IV; titrate by 2.5 mg/h q5-15 min	IV	continuous	INTERACT3 (PMID 37245517)
clevidipine	1-2 mg/h IV; double q90 sec	IV	continuous	Ultra-short acting (AHA/ASA 2022)
labetalol	10-20 mg IV bolus q10 min	IV	PRN	Adjunct for resistant HTN; sympathomimetic-induced cases (AHA/ASA 2022)

Plan: Deep-hypertensive ICH bundle — INTERACT3 aggressive BP + reversal + EVD + secondary prevention (AHA/ASA 2022 PMID 35579034; INTERACT3 PMID 37245517; INCH PMID 27302126; ANNEXA-I PMID 38749032)

3. When to call your provider

Contact your care team if any of the following happen:

Any new TIA-spectrum or stroke-like event → ED
BP persistently >140/90 despite 3-drug regimen → resistant HTN workup
PHQ-9 ≥15 or SI → urgent psych referral
Recurrent ICH → re-image, hold antithrombotic, escalate to vascular neurology

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Putaminal ICH — most common deep location; classic HTN bleed; contralateral hemiparesis + sensory loss + gaze deviation toward lesion (AHA/ASA 2022)
Thalamic ICH with IVH extension and obstructive hydrocephalus risk; sensory > motor deficit; vertical gaze palsy (AHA/ASA 2022)
Pontine / brainstem ICH on CT (typically hypertensive); GCS often ≤8; quadriparesis + cranial nerve deficits; 90-d mortality 50-80% (AHA/ASA 2022)(life-threatening)
Long-standing or uncontrolled hypertension with deep bleed — chronic-HTN mechanism (AHA cardiorenal PMID 35579034)
Sympathomimetic-induced deep ICH in young patient or without HTN history (AHA/ASA 2022)
Pituitary apoplexy or AVM rupture mimicking deep HTN bleed; warrant MRI + DSA
INTERACT3 (Ma Lancet 2023 PMID 37245517) care-bundle adherence — SBP <140 within 1 h + reversal + glucose + temp
CTA spot sign within 6 h predicts hematoma expansion 30%/6mL (AHA/ASA 2022)
Hematoma volume increase >33% or >6 mL on repeat CT (AHA/ASA 2022)

5. Follow-up

Long-term BP <130/80 STRICT (SPRINT-MIND); secondary-HTN workup if uncontrolled; anticoag restart at 4-8 wk FAVOURABLE for AF + high CHA2DS2-VASc + non-CAA phenotype (opposite of lobar CAA); lifestyle + statin restart (AHA/ASA 2022)

6. Sources

Guideline: 2022 AHA/ASA Guideline for Spontaneous ICH (Greenberg Stroke 2022) + INTERACT3 care bundle + INCH 4F-PCC + ANNEXA-I andexanet + SPRINT-MIND long-term BP