Emergency diagnosis and etiology assessment Emergency diagnosis and etiology assessment includes pre-hospital management, emergency room diagnosis and management, and acute phase diagnosis and treatment. Recommendation for pre-hospital management: Patients with sudden onset of symptoms suspected of stroke should be briefly evaluated and treated as an emergency and sent to the nearest available hospital as soon as possible (Class I recommendation). Recommendations for diagnosis and treatment in the emergency room of Du Quanyue, Department of Neurology, Baicheng Central Hospital: Patients with suspected stroke should undergo cranial CT or MRI examination as soon as possible to distinguish between hemorrhage and ischemia (Class I recommendation, Level A evidence); it is recommended that patients with suspected stroke should be diagnosed quickly and admitted to the neurological specialist ward or neurological care unit (NICU) as soon as possible (Class I recommendation, Level A evidence). Recommendations for diagnosis and treatment in the acute phase: cerebral hemorrhage is often followed by continued bleeding and progressive worsening neurological deficits within hours, with high mortality and morbidity, and should be diagnosed promptly and clearly (Class I recommendation, Level A evidence); early and comprehensive evaluation of patients with cerebral hemorrhage, including medical history, general and neurological examination, imaging and laboratory-related tests (Class I recommendation, Level D evidence). Among them, imaging recommendations: either CT or MRI is the first choice for initial imaging (Class I recommendation, Level A evidence); CTA and enhanced CT can help identify patients at high risk for hematoma expansion (Class II recommendation, Level B evidence); if there is clinical or imaging suspicion of underlying structural abnormalities such as vascular malformations or tumors, CTA, CTV, enhanced CT, enhanced MRI, MRA MRV may be useful for further evaluation (Grade II recommendation, Level B evidence); electrocardiography should be performed in all patients with cerebral hemorrhage (Grade I recommendation); the Glasgow Coma Scale or NIHSS scale is recommended to assess the severity of the disease (Grade III recommendation, Level C evidence); diagnosis is recommended with reference to the diagnostic process described above (Grade III recommendation, Level C evidence). Recommendations for treatment of acute cerebral hemorrhage Cranial hypertension Recommendations: Treatment of elevated intracranial pressure should be a balanced and gradual process, starting with simple measures such as elevation of the head of the bed, analgesia and sedation (Class I recommendation, Level D evidence); mannitol may be used intravenously (Class I recommendation, Level C evidence); glycerol fructose or furosemide or high-dose albumin may also be used if necessary (Class II recommendation, Level B evidence), but Long-term use is not recommended; transient hyperventilation can be applied intermittently in cranial hypertension crisis (Class I recommendation, Level B evidence); ventricular drainage is feasible in patients with hydrocephalus with decreased level of consciousness (Class I recommendation, Level B evidence); routine use of hypertonic saline to lower cranial pressure is not yet recommended, but only under the conditions of clinical trials or for cranial hypertension crisis where mannitol is ineffective (Class III recommendation, Level C evidence). Recommendations for blood pressure control: If systolic blood pressure >180 mmHg or diastolic blood pressure >100 mmHg in the acute phase of cerebral hemorrhage should be lowered, short-acting drugs can be used intravenously, and blood pressure changes should be closely monitored, with blood pressure monitoring every 5-15 minutes (Class III recommendation, Level C evidence), and a target blood pressure of 160/90 mmHg is desirable (Class III recommendation, Level C evidence); lowering the acute cerebral hemorrhage patient’s systolic blood pressure from 150 mmHg to 200 mmHg to 140 mmHg rapidly is likely to be safe (Class II recommendation, Level B evidence). Blood glucose recommendation: Blood glucose should be monitored to keep it within the normal range (Class III recommendation, Level C evidence). Hemostatic treatment recommendation: rFV IIa can limit the expansion of hematoma volume, but may increase the risk of thromboembolism, and the clinical effect is not known, so it is not recommended for widespread non-selective use (Grade I recommendation, Level A evidence). Neuroprotective agent recommendation: The efficacy and safety of neuroprotective agents need to be further confirmed by additional high-quality clinical trials (Class I recommendation, Level C evidence). Epileptic seizure recommendations: epileptic seizures with clinical seizures require antiepileptic treatment (Class I recommendation, Level A evidence); if altered mental status is disproportionate to brain injury, indication for 24-hour EEG monitoring (Class II recommendation, Level B evidence); patients with altered mental status with EEG epileptic waves should be given antiepileptic treatment (Class III recommendation, Level C evidence); prophylactic antiepileptic treatment is not recommended ( Grade II recommendation, Level B evidence); long-term drug treatment as usual for epilepsy for recurrent epileptiform seizures 2 to 3 months after stroke (Grade IV recommendation, Level D evidence). Recommendations for prevention of deep vein thrombosis and pulmonary embolism: For stroke patients with severe paralysis and long-term bed rest, attention should be paid to the prevention of deep vein thrombosis and pulmonary embolism; D-dimer screening test can be done early, and those who are positive can be further examined by Doppler ultrasound and MRI on the limb where deep vein thrombosis occurs (Class III recommendation, Level C evidence); encourage patients to move early, elevate their legs, and avoid lower limbs as much as possible IV infusions, especially in the paralyzed limb (Class IV recommendation, Level D evidence); prevention of DVT embolism with compression stockings and intermittent pneumatic compression (Class II recommendation, Level B evidence); in patients at high risk of DVT, low-dose subcutaneous injection of low-molecular heparin or heparin can be considered to prevent DVT formation after confirmation of cessation of bleeding, but the risk of bleeding should be noted (Class II recommendation, Level B evidence). . Recommendations for management of anticoagulation and fibrinolysis-related cerebral hemorrhage: fisetin sulfate is recommended for treatment of common heparin-associated cerebral hemorrhage, and the therapeutic dosage is inversely proportional to the time to discontinue heparin injection (Class III recommendation, Level C evidence); cerebral hemorrhage associated with elevated INR values of oral anticoagulants should discontinue anticoagulants and receive vitamin K-dependent coagulation factor therapy to correct INR values, and intravenous VitK may be used (Class III Grade II recommendation, Level C evidence); compared with fresh frozen plasma (FFP), prothrombin complex (PCC) has not shown a better prognosis but has fewer complications and can be used as an alternative treatment to FFP (Grade II recommendation, Level B evidence); although rFV IIa can reduce INR values, it is not recommended for routine use because it cannot replace all coagulation factors to restore coagulation in vivo as an antagonist for oral anticoagulant-associated cerebral hemorrhage (Class IV recommendation, Level D evidence); resumption of anticoagulation depends on the risk of secondary arterial or venous thrombosis, the risk of recurrent cerebral hemorrhage, and the patient’s overall status, e.g., a small risk of ischemic stroke and a high risk of amyloid cerebrovascular disease or poor neurologic function that may benefit more from antiplatelet aggregation drug therapy, e.g., thrombophilia high risk, warfarin may be reintroduced on days 7 to 10 of cerebral hemorrhage (Class II recommendation, Level B evidence); treatment of thrombolysis-related cerebral hemorrhage includes transfusion of coagulation factors and platelets (Class II recommendation, Level B evidence). Surgical treatment recommendations: For most patients with cerebral hemorrhage, the effectiveness of surgical treatment is inexact (Class III recommendation, Level C evidence). The following are some special cases: cerebellar hemorrhage >3 cm in diameter, such as continued neurological deterioration, brainstem compression, ventricular obstruction causing hydrocephalus, should be surgically removed as soon as possible (Class II recommendation, Level B evidence); ventricular drainage alone is not recommended and surgical hematoma removal should be performed at the same time (Class III recommendation, Level C evidence); lobar hematoma within 1 cm of the brain surface and with a hemorrhage volume >30 ml The efficacy of minimally invasive clot removal with stereotactic and/or endoscopic aspiration (with or without thrombolytic drugs) is to be further confirmed (Class II recommendation, Level B evidence); there is insufficient evidence that ultra-early craniotomy improves functional outcome or reduces mortality, and very early craniotomy may increase the risk of rebleeding (Class II recommendation, Level B evidence). (Level II recommendation, Level B evidence); minimally invasive hematoma crush removal can be considered for moderate-to-large basal ganglia hemorrhage within 72 hours (Level II recommendation, Level B evidence).