Intracerebral hemorrhage

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Nontraumatic intracerebral hemorrhage (ICH) remains a common management dilemma for neurosurgeons. Intracerebral hemorrhage represents approximately 15% of all strokes and the 30-day mortality rate ranges from 40% to 50%, with significant disability in survivors.1 Despite advances in the rapid diagnosis of the disorder, few effective treatments for ICH have been realized. There is increasing evidence that initial ICHs progress in the first few hours,2 and pharmacological therapy to prevent rehemorrhage has been only equivocally effective.3 It appears logical that surgical removal of the mass and potential toxic constituents of the hematoma with coagulation of the bleeding site should be an effective therapy. Nevertheless, multiple surgical trials have shown limited or no benefit to surgery, including a large international multicenter randomized trial.4 The advent of minimally invasive techniques and use of thrombolytic agents to facilitate clot removal are exciting new adjuncts to therapy, but remain unproven.

The current issue of Neurosurgical Focus explores a number of topics related to existing and future treatments for ICH, prognostic factors that determine outcome, and features related to the pathophysiology of brain damage. Dr. Amar summarizes ongoing neurosurgical controversies in the management of ICH and its consequences. Levy et al. explore the increasingly frequent occurrence of ICH associated with cerebral revascularization treatments and thrombolysis. Abdu and colleagues present a new technology that may enable the rapid and minimally invasive removal of an ICH and intraventricular hemorrhage. Basaldella et al. examine the effect of endoscopic surgery on subsequent shunt dependence for intraventricular hemorrhage. Zacharia and associates describe factors that predict hydrocephalus following ventriculostomy associated with ICH. Conti et al. relate their experience with a telenetwork triage system for ICH, and Selman et al. review the literature pertinent to ICH associated with cerebral amyloid angiopathy. Finally, Adamson and colleagues review the mechanisms of brain injury directly referable to the thrombus constituents.

It is hoped that this collection of topics related to ICH will provide a better understanding of this common and devastating disorder, and potentially lead to new research regarding effective therapies.

Disclosure

The authors report no conflict of interest.

References

  • 1

    Broderick JConnolly SFeldmann EHanley DKase CKrieger D: Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Circulation 116:e391e4132007

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  • 2

    Brott TBroderick JKothari RBarsan WTomsick TSauerbeck L: Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke 28:151997

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  • 3

    Mayer SABrun NCBegtrup KBroderick JDavis SDiringer MN: Recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med 352:7777852005

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  • 4

    Mendelow ADGregson BAFernandes HMMurray GDTeasdale GMHope DT: Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet 365:3873972005

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Article Information

Please include this information when citing this paper: DOI: 10.3171/2012.2.FOCUS1279.

© AANS, except where prohibited by US copyright law.

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References

  • 1

    Broderick JConnolly SFeldmann EHanley DKase CKrieger D: Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Circulation 116:e391e4132007

    • Search Google Scholar
    • Export Citation
  • 2

    Brott TBroderick JKothari RBarsan WTomsick TSauerbeck L: Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke 28:151997

    • Search Google Scholar
    • Export Citation
  • 3

    Mayer SABrun NCBegtrup KBroderick JDavis SDiringer MN: Recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med 352:7777852005

    • Search Google Scholar
    • Export Citation
  • 4

    Mendelow ADGregson BAFernandes HMMurray GDTeasdale GMHope DT: Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet 365:3873972005

    • Search Google Scholar
    • Export Citation

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