(New recommendation) Systematic screening for myocardial ischemia or infarction with electrocardiogram and cardiac enzyme testing after ICH is reasonable (Class IIa; Level of Evidence C). (New recommendation) Procedures/Surgery ICP Monitoring and Treatment Limited data exist regarding the frequency of elevated ICP and its management in patients with ICH.182 185 A recently reported Hemphill et al Management of Spontaneous ICH 2043 cohort study of 243 consecutive ICH patients described ICP episode of intracranial hypertension (defined as an ICP >20 In a randomized trial of intraventricular thrombol- ysis in 100 patients with intraventricular hemorrhage (IVH) and ICH smaller than 30 mm3 , ICP was >20 mmHg at the time of ventricular catheter (VC) insertion in 14 patients.184 Overall, however, ICP was not frequently elevated during monitoring and VC drainage in these patients. There is evidence for dif- ferential pressure gradients in at least some cases of ICH, so that ICP may be elevated in and around the hematoma but not distant from it.186 Because the usual causes of elevated ICP are hydrocephalus from IVH or mass effect from the hematoma (or surrounding edema), patients with small hematomas and limited IVH usually will not require treatment to lower ICP. Increased ICP also may be more common in younger patients and those with supratentorial ICH.185 Hydrocephalus is associ- ated with worsened outcome in acute ICH.187 189 patients with follow-up data who were randomized into the international Surgical Trial for Intracerebral Haemorrhage (STICH), 377 had IVH, and 208 of these had hydrocephalus (23% of all patients, 55% of those with IVH).190 ICP is measured by use of devices inserted into the brain parenchyma or cerebral ventricles. Fiber optic technology can be used in both types of devices. 