Cerebral Hemorrhage: Pathophysiology, Treatment, and Future Directions

Abstract

Intracerebral hemorrhage (ICH) is a devastating form of stroke with high morbidity and mortality. This review article focuses on the epidemiology, cause, mechanisms of injury, current treatment strategies, and future research directions of ICH. Incidence of hemorrhagic stroke has increased worldwide over the past 40 years, with shifts in the cause over time as hypertension management has improved and anticoagulant use has increased. Preclinical and clinical trials have elucidated the underlying ICH cause and mechanisms of injury from ICH including the complex interaction between edema, inflammation, iron-induced injury, and oxidative stress. Several trials have investigated optimal medical and surgical management of ICH without clear improvement in survival and functional outcomes. Ongoing research into novel approaches for ICH management provide hope for reducing the devastating effect of this disease in the future. Areas of promise in ICH therapy include prognostic biomarkers and primary prevention based on disease pathobiology, ultra-early hemostatic therapy, minimally invasive surgery, and perihematomal protection against inflammatory brain injury.

The roles, mechanism, and mobilization strategy of endogenous neural stem cells in brain injury

“…According to the site of hemorrhage, the ICH divide into subarachnoid hemorrhage, subdural hemorrhage, lobar intracerebral hemorrhage and deep intracerebral hemorrhage (the basal ganglia, periventricular white matter, internal capsule, brainstem, and so on ( Carpenter et al, 2016 ; Ziai and Carhuapoma, 2018 ). The hematoma and hydrocephalus cased by ICH not only destroy the neural cells in brain parenchyma and increases intracranial pressure, but also result in the ischemic brain injury in the areas far from the bleeding site, and exacerbate the brain injury ( Bhattacharjee et al, 2021 ; Magid-Bernstein et al, 2022 ).…”

Iron-Induced Oxidative Stress in Human Diseases

“…Even under normal conditions, iron may cause pathological damage depending on local conditions to produce redox-active iron. For example, free catalytic iron may be present in ischemic [ 6 , 7 ] or inflammatory lesions [ 8 , 9 ] and thus result in iron-induced oxidative stress because the pH in such lesions decreases [ 10 ], owing to which iron is solubilized as ions. Therefore, iron is the mastermind behind many systemic and local human diseases.…”

Prediction Model of Hemorrhage Transformation in Patient with Acute Ischemic Stroke Based on Multiparametric MRI Radiomics and Machine Learning

“…However, this therapy is often accompanied by the complication of HT. Once HT occurs, the disability rate and mortality rate of patients can be as high as 90.0% and 50.0–80.0%, respectively [ 2 , 3 ]. Considering the risk of HT, doctors cannot make decisions quickly, which affects the rescue of patients, and severely limits the clinical application of rt-PA intravenous thrombolytic therapy.…”