Management of intracerebral hemorrhage

Thabet, Ahmad M.; Kottapally, Mohan; Hemphill, J. Claude

doi:10.1016/b978-0-444-63600-3.00011-8

Cited by 64 publications

(43 citation statements)

References 171 publications

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“…Intracerebral hemorrhage (ICH), which accounts for 10–15% of all strokes, is the second most detrimental subtype of stroke 1 , 2 . ICH is more severe and disabling than ischemic stroke; it has the highest mortality rate of all the strokes 3 , 4 .…”

Section: Introductionmentioning

confidence: 99%

Plasma homocysteine concentrations and risk of intracerebral hemorrhage: a systematic review and meta-analysis

Zhou

Liang

et al. 2018

Sci Rep

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Intracerebral hemorrhage (ICH) has the highest mortality rate in all strokes. However, controversy still exists concerning the association between plasma homocysteine (Hcy) and ICH. A systematic review and meta-analysis was conducted using Pubmed, Embase, and Web of Science up to April 18, 2017. Standard mean difference (SMD) for mean differences of plasma Hcy levels with 95% confidence intervals (CI) was calculated. Seven studies including 667 ICH patients and 1821 ischemic stroke patients were identified for meta-analysis. Our results showed that Hcy levels in ICH patients were significantly higher than those in healthy controls (SMD = 0.59, 95% CI = 0.51–0.68, P < 0.001); no statistic differences were found in the comparisons of Hcy levels between ICH and ischemic stroke (SMD = −0.03, 95% CI = −0.13–0.06, P > 0.05); further subgroup analysis of ethnicity (Asians: SMD = 0.57, 95% CI = 0.48–0.66, P < 0.001; Caucasians: SMD = 0.77, 95% CI = 0.51–1.02, P < 0.001) and sample size (small samples: SMD = 0.55, 95% CI = 0.30–0.80, P < 0.001; large samples size: SMD = 0.60, 95% CI = 0.51–0.69, P < 0.001) in relation to Hcy levels between ICH and healthy controls did not change these results. In conclusion, Hcy level may be an aggravating factor in atherosclerosis, which is positively associated with high risk of ICH. Race-specific differences between Asians and Caucasians have no impact on the risk of ICH.

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Section: Introductionmentioning

confidence: 99%

Plasma homocysteine concentrations and risk of intracerebral hemorrhage: a systematic review and meta-analysis

Zhou

Liang

et al. 2018

Sci Rep

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“…ICH is estimated to affect over 1 million people worldwide each year 1 , and that number is expected to rise substantially as the population ages. Most patients with ICH die or become severely disabled, and supportive care is the mainstay of current therapy 4,5 . Primary brain damage develops within the first few hours after ICH as a result of haematoma or oedema, formation and expansion of which induces mass effects and increased intracranial pressure that can lead to herniation and death.…”

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confidence: 99%

Modulators of microglial activation and polarization after intracerebral haemorrhage

et al. 2017

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Intracerebral haemorrhage (ICH) is the most lethal subtype of stroke but currently lacks effective treatment. Microglia are among the first non-neuronal cells on the scene during the innate immune response to ICH. Microglia respond to acute brain injury by becoming activated and developing classic M1-like (proinflammatory) or alternative M2-like (anti-inflammatory) phenotypes. This polarization implies as yet unrecognized actions of microglia in ICH pathology and recovery, perhaps involving microglial production of proinflammatory or anti-inflammatory cytokines and chemokines. Furthermore, alternatively activated M2-like microglia might promote phagocytosis of red blood cells and tissue debris, a major contribution to haematoma clearance. Interactions between microglia and other cells modulate microglial activation and function, and are also important in ICH pathology. This Review summarizes key studies on modulators of microglial activation and polarization after ICH, including M1-like and M2-like microglial phenotype markers, transcription factors and key signalling pathways. Microglial phagocytosis, haematoma resolution, and the potential crosstalk between microglia and T lymphocytes, neurons, astrocytes, and oligodendrocytes in the ICH brain are described. Finally, the clinical and translational implications of microglial polarization in ICH are presented, including the evidence that therapeutic approaches aimed at modulating microglial function might mitigate ICH injury and improve brain repair.

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“…Hemostatic therapy (e.g., Factor VIIa, FAST trial NCT00127283; Tranexamic acid, TRAIGE trial, NCT02625948; platelet transfusion, PATCH trial, NCT02187120) and reducing blood pressure (e.g., ATACH, NCT01176565; INTERACT, NCT00716079) have undergone clinical trials to limit continued bleeding (clot expansion) in the early phase (< 24 h) after ICH. Although some of these studies have reported statistically significant effects on limiting bleeding, there has yet to be definitive evidence of improved outcomes [ 152 – 160 ].…”

Section: Review Of Clinical Trialsmentioning

confidence: 99%

Opportunities in posthemorrhagic hydrocephalus research: outcomes of the Hydrocephalus Association Posthemorrhagic Hydrocephalus Workshop

Koschnitzky

Keep

Limbrick

et al. 2018

Fluids Barriers CNS

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The Hydrocephalus Association Posthemorrhagic Hydrocephalus Workshop was held on July 25 and 26, 2016 at the National Institutes of Health. The workshop brought together a diverse group of researchers including pediatric neurosurgeons, neurologists, and neuropsychologists with scientists in the fields of brain injury and development, cerebrospinal and interstitial fluid dynamics, and the blood–brain and blood–CSF barriers. The goals of the workshop were to identify areas of opportunity in posthemorrhagic hydrocephalus research and encourage scientific collaboration across a diverse set of fields. This report details the major themes discussed during the workshop and research opportunities identified for posthemorrhagic hydrocephalus. The primary areas include (1) preventing intraventricular hemorrhage, (2) stopping primary and secondary brain damage, (3) preventing hydrocephalus, (4) repairing brain damage, and (5) improving neurodevelopment outcomes in posthemorrhagic hydrocephalus.

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Management of intracerebral hemorrhage

Cited by 64 publications

References 171 publications

Plasma homocysteine concentrations and risk of intracerebral hemorrhage: a systematic review and meta-analysis

Plasma homocysteine concentrations and risk of intracerebral hemorrhage: a systematic review and meta-analysis

Modulators of microglial activation and polarization after intracerebral haemorrhage

Opportunities in posthemorrhagic hydrocephalus research: outcomes of the Hydrocephalus Association Posthemorrhagic Hydrocephalus Workshop

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