Emerging experimental therapies for intracerebral hemorrhage: targeting mechanisms of secondary brain injury

Abstract

<jats:p>Intracerebral hemorrhage (ICH) is associated with a higher degree of morbidity and mortality than other stroke subtypes. Despite this burden, currently approved treatments have demonstrated limited efficacy. To date, therapeutic strategies have principally targeted hematoma expansion and resultant mass effect. However, secondary mechanisms of brain injury are believed to be critical effectors of cell death and neurological outcome following ICH. This article reviews the pathophysiology of secondary brain injury relevant to ICH, examines pertinent experimental models, and highlights emerging therapeutic strategies. Treatment paradigms discussed include thrombin inhibitors, deferoxamine, minocycline, statins, granulocyte-colony stimulating factors, and therapeutic hypothermia. Despite promising experimental and preliminary human data, further studies are warranted prior to effective clinical translation.</jats:p>

Comparative analysis of predictive significance of neuroimaging parameters in patients with spontaneous supratentorial intracerebral hemorrhage

“…At the same time, SSICH is a pathomorphologically heterogeneous process [2,6,15,18]. In 40-50 % of cases SSICH is accompanied by the following complication: the blood breakthrough into the brain ventricular system [4,7,16].…”

Blood Glutamate Grabbing Does Not Reduce the Hematoma in an Intracerebral Hemorrhage Model but it is a Safe Excitotoxic Treatment Modality

“…Early administration of hemostatic agents, meticulous blood pressure control, and early surgical evacuation and catheter hematoma aspiration have also been used to limit hematoma expansion. 3 Therefore, to improve the clinical outcome of ICH and better understand its pathogenesis, induced brain injury is in high demand. 1 Several lines of evidence suggest that glutamate is involved in the secondary damage of ICH.…”

Sparstolonin B improves neurological outcomes following intracerebral hemorrhage in mice

“…Inflammatory processes serve a critical role in the secondary damage following ICH; indeed, several studies have indicated that the inflammatory reaction is one of the main mechanisms that induces the secondary damage associated with ICH (24,25). Secondary brain injury following ICH includes hematoma toxicity, high metabolic injury, excitotoxicity, oxidative stress and inflammatory injury (1,(9)(10)(11).…”