Integral Components of the History, Physical Examination, and Workup of the Patient With ICH in the Emergency Department Comments History Time of symptom onset (or time the patient was last normal) Initial symptoms and progression of symptoms Vascular risk factors History of stroke or ICH, hypertension, diabetes mellitus, and smoking Medications Anticoagulant drugs, antiplatelet agents, antihypertensive medications, stimulants (including diet pills), sympathomimetic drugs Recent trauma or surgery Carotid endarterectomy or carotid stenting, because ICH may be related to hyperperfusion after such procedures Dementia Associated with amyloid angiopathy Alcohol or illicit drug use Cocaine and other sympathomimetic drugs are associated with ICH, stimulants Seizures Liver disease May be associated with coagulopathy Cancer and hematologic disorders May be associated with coagulopathy Physical examination Vital signs A general physical examination focusing on the head, heart, lungs, abdomen, and extremities A focused neurological examination A structured examination such as the National Institutes of Health Stroke Scale can be completed in minutes and provides a quantification that allows easy communication of the severity of the event to other caregivers. GCS score is similarly well known and easily computed. Serum and urine tests Complete blood count, electrolytes, blood urea nitrogen and creatinine, and glucose Higher serum glucose is associated with worse outcome16,17 Prothrombin time (with INR) and an activated partial thromboplastin time Warfarin-related hemorrhages are associated with an increased hematoma volume, greater risk of expansion, and increased morbidity and mortality18,19 Cardiac-specific troponin Elevated troponin levels are associated with worse outcome20,21 Toxicology screen to detect cocaine and other sympathomimetic drugs of abuse Cocaine and other sympathomimetic drugs are associated with ICH Urinalysis and urine culture, as well as a pregnancy test in a woman of childbearing age Other routine tests Neuroimaging CT or MRI; consider contrast-enhanced or vascular imaging ECG To assess for active coronary ischemia or prior cardiac injury; ECG abnormalities can mark concomitant myocardial injury22,23 CT indicates computed tomography; GCS, Glasgow Coma Scale; ICH, intracerebral hemorrhage; INR, international normalized ratio; and MRI, magnetic resonance imaging. 