Due to a wide spectrum of clinical and radiological presentation of the HEVA, its neurosurgical handling of brain hemorrhage is a controversial theme, despite the effort of several authors to uniform the conduct for these cases.
Because of its high costs, MRI is generally reserved to the cases of non-hypertensive etiology of HEVA.
The primary object in pre-hospital care is to maintain a ventilator and cardiovascular proper support and to provide, the sooner the better, the transfer of the patient to a facility which is prepared for a patient with HEVA.
Thus, in a general way, the treatment of the SAH must be more aggressive than in the ischemic HEVA and it must be instituted as soon as possible.
The neurological status of the patient must be followed and re-evaluated in short intermissions using standardized neurologic scores as the HEVA scores for NIH and the coma Glasgow score and score of ICH.
There is a large spectrum of clinical presentations of patients with HEVA that may determine the indication (or not) of a neurosurgical intervention (4,10).
Although we do not find data in literature with good levels of evidence that estimate the incidence and the correct handling of the ICP, it is known that there is a high incidence of raise in the ICP in patients with HEVA.