Historical collection · First published May 22, 2025; added to EM Weekly Oct 27, 2026. This retrospective summary may be superseded by later evidence or guidance.
← All articlesEuropean Stroke Organisation (ESO) and European Association of Neurosurgical Societies (EANS) guideline on stroke due to spontaneous intracerebral haemorrhage
Summary
This GRADE guideline updates spontaneous ICH management across 37 clinical questions. It favors stroke-unit care and advises against using the ICH score alone to determine prognosis. For minor-to-moderate ICH, it suggests early controlled systolic BP lowering below 140 mmHg while avoiding excessive reductions.
Why it matters
Use a coordinated ICH pathway and early specialist input. Avoid blanket treatment-limitation policies in the first 24 hours; individual patient wishes and clinical context remain essential.
Study at a glance
- Design
- Guideline
- Population
- Adults with spontaneous, nontraumatic intracerebral hemorrhage.
- Sample size
- Not applicable
- Intervention
- Updated acute ICH care recommendations.
- Comparator
- Prior 2014 ESO guidance and usual care.
- Primary endpoint
- Mortality, dependence and other critical clinical outcomes.
Main findings
- The BP consensus advises avoiding a fall >70 mmHg from baseline or actively lowering systolic BP below 110 mmHg.
- Stroke-unit care is strongly recommended for patients who do not require intensive care.
Limitations
Many recommendations are weak or consensus-based. BP guidance is most applicable to hematomas <30 mL and does not establish benefit for every severe or surgical ICH.
Recommendation strength
Stroke-unit care: strong/moderate certainty. Acute BP targets and early prognostic cautions include expert consensus; many other recommendations are weak.
Read the primary source
Full text: Open-access full text available.
Original sourceDOI: 10.1177/23969873251340815
PMID: 40401775
Material reviewed: full text.
Source retrieved Oct 27, 2026. Historical backfill. Primary open-access guideline abstract, methods and relevant recommendation table sections on stroke-unit care, BP and prognosis reviewed; not every supplement or recommendation was appraised. Electronic date May 22, 2025 verified from PubMed XML. This is European guidance; local US protocols may differ.
Corrections & review history
No corrections recorded. Human review: not yet human-reviewed.