الفهرس 
NARRATIVE REVIEW
Clinical spectrum of CAAOnly 14 pages are availabe for public view
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Abstract
Primary spontaneous lobar intracerebral hematomas (ICH) are intraxial
bleeding in the brain parynchema not due to trauma, underlying pathology (vascular
malformation, neoplastic, etc.) or general pathology such as coagulopathy. It is usually
associated with microvascular pathology related to hypertension or chronic amyloid
angiopathy. They account for 10 to 15% of cerebrovascular accidents; 60% of this
ratio shows either significant morbidity or mortality.
The role and timing of surgery in management of ICH. is controversial.
Results of previous trials regarding surgery versus medical management of ICH have
been equipoise. Some studies favored surgical management, while others favored
conservative management (Teernstra, Evers, Lodder, Leffers, Franke, Blaauw, et al.
2003).
Also, a meta-analysis of 12 trials was slightly in favor of surgical treatment (Prasad
and Shrivastava 2000) , likewise the results of STICH I trial.
A recent meta-analysis on supratentorial ICH., suggests a benefit of surgery in the
following situations:
• Patients under age 69
• GCS between 8 and 12
• Hematoma volume between 20 and 50 ml
• No associated IVH
• Surgery performed within 8 hours of onset of symptoms
• ICH located less than a centimeter from the cortex.
The most recent American heart association guidelines for management of ICH.
explored different methods of management of such condition. A conclusion has been
made stating that most ICH. will not benefit from surgery with exception of cerebellar
hematomas causing neurological deterioration, brain stem compression or
hydrocephalus as well as supratentorial lobar hematomas surgically sizable ; > 30 ml
and within 1 cm from cortical surfac .
The above mentioned studies didn’t sufficiently answer the question of
management of patients with lobar ICH; hence, STICH II trial has been started.
Our review seeks to address the question of conservation vs surgical management
of patients with primary spontaneous lobar ICH.