Update on intracerebral haemorrhage

Abstract

Intracerebral haemorrhage (ICH) is a common and serious disease. About 1 to 2 out of 10 patients with stroke have an ICH. The mortality of ICH is higher than that of ischaemic stroke. Only 31% are functionally independent at 3 months. Only 38% of the patients survive the 1(st) year. The cost of ICH is high. Hypertension is the major risk factor, increasing the risk of ICH about 4x. Up to half of hypertensive patients who suffer a ICH are either unaware of their hypertension, non-compliant with the medication or fail to control periodically their blood pressure levels Microbleeds and white matter changes are MRI markers of the risk of ICH. ICH has 3 main pathophysiological phases: arterial rupture and haematoma formation, haematoma enlargement and peri-haematoma oedema. Up to 40% of the haematomas grow in the first hours post-rupture. ICH growth is associated with early clinical deterioration. Two randomised clinical trials (RCTs) demonstrated that treatment with rFVIIa limited haematoma growth and improved outcome, but was associated with a increase in thromboembolic complications. Ventricular drainage with thrombolytics might improve outcome for patients with intraventricular bleeding. A large RCT and meta-analysis failed to show a benefit of surgery over conservative treatment in acute ICH.

Incidence of Hemorrhagic Stroke in Black Caribbean, Black African, and White Populations

“…Lobar hemorrhage in older people is often due to cerebral amyloid angiopathy. 2 The BC and BA groups were significantly younger than the whites and might therefore be less likely to have amyloid angiopathy as the cause of stroke.…”

“…1 Reasons for this finding might be a different risk of hemorrhagic stroke among ethnic groups or a different distribution of main risk factors among the populations. 2,3 There is a 2 to 3 times higher incidence in the United States black population compared with whites for PICH and SAH. 4 -6 Similar ethnic differences in hemorrhagic stroke risk have been observed in previous studies in South London.…”

Cigarette Smoking, Systolic Blood Pressure, and Cardiovascular Diseases in the Asia-Pacific Region

“…31,32 This accounts for the stronger association between BP and hemorrhagic stroke risk compared with CHD, although the risk related to increased levels of BP is similar for ischemic and hemorrhagic stroke. 4,5 By contrast, the excess risk attributable to smoking for hemorrhagic stroke is less than it is for either CHD or ischemic stroke.…”

Increased risk of intracerebral hemorrhage among patients with chronic osteomyelitis

“…10,28,31 Patients with ICH are at higher risk of disability than those with ischemic stroke, inclusive of greater economic and health care burdens. Exhibiting in 10%-20% of all strokes, ICH has been associated with both noninfectious and infectious factors.…”

“…9,15,32 Among noninfectious factors, pathological changes in the cerebral arterioles, including proliferation and death of arteriolar smooth muscle cells and arteriolar ectasia with microaneurysm formation 31 in the cerebral arterioles, may subsequently lead to the rupture of arteriolar microaneurysms, causing ICH. 10,28,31 These noninfectious pathological changes can be triggered by some conventional risk factors for ICH, such as hypertension, diabetes, hyperlipidemia, and chronic kidney disease (CKD). 16,18,20,21,24 However, risk factors for 10%-25% of ICH patients remain unclear, especially in the younger population.…”