Intracerebral hemorrhage: effective therapy at last?

After decades of relative neglect, the past few years have been particularly eventful for clinical research into spontaneous intracerebral hemorrhage (ICH). Most importantly, we have seen completion of the first large randomized trial of surgical clot evacuation for supratentorial ICH, and also the first trial to demonstrate the efficacy of systemic recombinant factor 7 to stop parenchymal bleeding and prevent clinical worsening. Other important advances include new insights into risk factors, diagnostic imaging, pathophysiology of cellular injury, brain edema and blood flow, blood pressure management, aspiration of parenchymal and intraventricular clots; stem cell therapy, and outcome. Taken together, the impressive scope and progress of ongoing clinical and basic research demonstrate that there is no longer a place for nihilism in the approach to ICH.