Intracerebral hemorrhage: an update on diagnosis and treatment

Abstract

Introduction: Spontaneous nontraumatic intracerebral hemorrhage (ICH) is most often caused by small vessel diseases: hypertensive arteriopathy or cerebral amyloid angiopathy (CAA). Although ICH accounts for only 10-15% of all strokes it causes a high proportion of stroke mortality and morbidity, with few proven effective acute or preventive treatments. Areas covered: We conducted a literature search on etiology, diagnosis, treatment, management and current clinical trials in sICH. In this review we describe the causes, diagnosis, (including new brain imaging biomarkers), classification, pathophysiological understanding, treatment (medical and surgical) and secondary prevention of ICH. Expert commentary: In recent years, significant advances have been made in deciphering causes, understanding pathophysiology, and improving acute treatment and prevention of ICH. However, the clinical outcome remains poor and many challenges remain. Acute interventions delivered rapidly (including medical therapies-targeting hematoma expansion, hemoglobin toxicity, inflammation, edema, anticoagulant reversaland minimally-invasive surgery) are likely to improve acute outcomes. Improved classification of the underlying arteriopathy (from neuroimaging and genetic studies) and prognosis should allow tailored prevention strategies (including sustained blood pressure control and optimized antithrombotic therapy) to further improve longer-term outcome in this devastating disease.

Mechanism Study of the Protective Effects of Sodium Tanshinone IIA Sulfonate Against Atorvastatin-Induced Cerebral Hemorrhage in Zebrafish: Transcriptome Analysis

“…The expression levels of genes of interest, which encode hemoglobin, Na+/H+ exchanger, and carbonic anhydrase, were verified by real-time PCR analysis. Hemoglobin proteins caused dramatic neuronal toxicity in cerebral hemorrhage and regulated the oxygen and carbon dioxide exchange with carbonic anhydrase in blood cells ( Hostettler et al, 2019 ; Nikinmaa et al, 2019 ). We found that the mRNA expression levels of hemoglobin ( hbae1.3, hbae3, hbae5, hbbe2 and hbbe3 ), Na+/H+ exchanger ( slc4a1a and slc9a1 ), and carbonic anhydrase ( cahz ) genes were significantly elevated after cerebral hemorrhage, while STS alleviated the expression changes in of these genes ( Figure 4 ).…”

Dl-3-n-Butylphthalide promotes neovascularization and neurological recovery in a rat model of intracerebral hemorrhage

“…The pathogenesis and pathophysiology underlying ICH are complex. The space-occupying effect of the hematoma along with blood infiltration into the brain parenchyma could trigger multiple cellular and molecular responses around and beyond the lesion site, such as ischemia, blood-brain barrier disruption, oxidative stress and neuroinflammation, which may result in acute and chronic neuronal damage and neurological dysfunction [8,12,15]. Clinical trials suggest that vasospasm of larger brain vessels is not the sole contributor to neurological outcome, and intense efforts have been turned to mechanisms of early brain injury that may play a larger role in functional outcome, including neuroinflammation and microvascular dysfunction [47].…”

“…Much progress has been made in recent years in understanding the pathogenesis of ICH [7,10]. However, unfortunately, none of the current clinical interventions, including aggressive blood pressure control, homeostasis management and platelet transfusion, have significantly improved the outcome of cerebral stroke among patients [11][12][13][14][15][16].…”

Evaluation of subacute subarachnoid haemorrhage detection using a magnetic resonance imaging sequence: Double Inversion Recovery

“…I ntracranial haemorrhage (ICH) as a common stroke subtype, caused by blood leaking into the brain parenchyma. This critical neurologic injury is responsible for 10-20% of strokes [1][2][3][4][5]. ICH comprises four different types: epidural and subdural hematoma, intracerebral haemorrhage, and subarachnoid haemorrhage (SAH).…”