Decoding spontaneous intracerebral hemorrhage: mechanistic breakthroughs and disruptive revolution in pharmacological treatment

Spontaneous intracerebral hemorrhage (ICH), especially hypertensive basal ganglia hemorrhage, is a severe, often fatal stroke subtype with high morbidity and mortality. This historical review traces therapeutic progress from the 1960s to the present, emphasizing rehabilitation, peripheral–central nervous system interactions, and clinical outcomes. Molecular mechanisms, early treatments, and advances in interventions are examined. Rehabilitation strategies, such as exercise programs, stem cell therapies, and novel physical modalities, are evaluated for their effects on neuroprotection, neuroplasticity, and functional recovery. Pharmacological approaches during subacute and chronic phases are also reviewed. Clinical trials (phases I–III) are critically assessed for end points and efficacy of combined therapies. This Review highlights emerging paradigms targeting peripheral–central pathways, personalized rehabilitation, and future directions, while addressing research limitations and clinical challenges.