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Stroke is the leading cause of neurological disability in people over 40 years of age and the fourth leading cause of death in Argentina. In the last ten years, the indexed publications related to the treatment of ischemic stroke were more numerous than those of hemorrhagic stroke. The objective of this material is to provide local and updated recommendations for the management of patients with spontaneous intracerebral hemorrhage during hospitalization. For the writing of this manuscript, diferent specialists were convened to form working groups. Ten central topics expressed as epidemiology, initial care, imaging, blood pressure treatment, reversal of antithrombotics, indication for surgery, seizure prophylaxis, prognosis, prevention of complications and resumption of antithrombotics were raised. For each topic, the most frequent questions of daily practice were raised through PICO questions. After a systematic review of the literature, recommendations were generated, evaluated using the GRADE system and agreed between authors and patients.El accidente cerebrovascular (ACV) constituye la principal causa de discapacidad de origen neurológico en los adultos mayores a 40 años y la cuarta causa de muerte en Argentina. En los últimos diez años las publicaciones indexadas relacionadas al tratamiento del ACV isquémico fueron más numerosas que las de ACV hemorrágico. El objetivo de este material es proporcionar recomendaciones locales y actualizadas del abordaje de pacientes con hematoma intraparenquimatoso espontáneo durante la internación. Para la redacción de este manuscrito se convocó a especialistas en esta enfermedad que conformaron grupos de trabajo. Se plantearon 10 tópicos centrales expresados como epidemiologia, atención inicial, imágenes, tratamiento de la presión arterial, reversión de antitrombóticos, indicación de cirugía, profilaxis anticonvulsivante, pronóstico, prevención de complicaciones y reinicio de antitrombóticos. De cada tópico se plantearon mediante preguntas PICO los interrogantes más frecuentes de la práctica diaria. Luego de una revisión sistemática de la literatura, se generaron recomendaciones evaluadas mediante sistema GRADE y consensuadas entre autores y pacientes.

A 72-year-old woman was admitted to the Intensive Care Unit (ICU) with right-sided hemiparesis and mixed aphasia; an axial brain computed tomography (CT) with no acute injuries and the angiotomography showed a 50% stenosis of the intracranial left internal carotid. Presented a National institute of Health Stroke Scale (NIHSS) score of 23, whereby she received fibrinolytic treatment with endovenous tissue plasminogen activator (rTPA) 170 min after the symptoms started. An electrocardiogram (ECG) and echocardiogram revealed an acute myocardial infarction (MI) with a ST-segment elevation at the inferior face. After the fibrinolytic treatment, the patient presented criterion for myocardial reperfusion. She evolved favourably and was discharged from the ICU after 48 h with a NIHSS score of 9. The aim of the present case report is, therefore, to suggest a clinical approach to help physicians in the decision-making process for treatment in patients with concurrent hyperacute cardio-cerebral infarction (CCI).