Hematoma expansion in intracerebral hemorrhage – the right target?

Abstract

Background The avoidance of hematoma expansion is the most important therapeutic goal during acute care of patients with intracerebral hemorrhage. Hematoma expansion occurs in up to 20–40% of patients and leads to poorer patient outcome in one of the most severe sub-types of stroke. Main text At current, randomized controlled trials have failed to provide evidence for interventions that effectively improve functional outcome in patients with intracerebral hemorrhage. Hence, hematoma expansion may serve as important surrogate target that appears causally linked with a poorer prognosis. Therefore, reduction of hematoma expansion rates will eventually translate to improved patient outcome overall. Recent years have shed light on the importance of early and aggressive treatment in order to reduce the risk for hematoma expansion in these patients. Time measures and imaging markers have been identified that may allow patient selection at very high risk for hematoma expansion. Conclusions Refinements in patient selection may increase chance for randomized trials to show true benefit. Therefore, this current review article will critically evaluate and discuss available evidence associated with hematoma expansion in patients with intracerebral hemorrhage.

Black hole sign migration in short-term brain CT scans: A possible link with clot evolution and histology

“…The bleeding phases are categorized as hyperacute (<24 h), acute (24-72 h), subacute (72 h-13 days), and chronic (>14 days) [9] . Hematoma expansion risk peaks within the first 3 hours after neurological onset, observed in approximately 33% of cases [10] . During the acute phase, the clot appears hyperdense compared to normal brain tissue, following a hyperacute phase characterized by iso-hypodensity due to the challenge of ionizing radiations to capture blood turbulence [11] .…”

An End-to-End Deep Learning Framework for Predicting Hematoma Expansion in Hemorrhagic Stroke Patients from CT Images

“…It occurs in 30-38% of patients with ICH, and it can drastically worsen functional outcome and lead to disability and death [4]. For instance, for each 1 mL of absolute increase in hematoma volume, patients are 7% more likely to worsen from independence to poor outcome [5]. Therefore, it is crucial to rapidly identify patients at risk of HE at the time they present with intracerebral hemorrhage.…”

The clinical potential of radiomics to predict hematoma expansion in spontaneous intracerebral hemorrhage: a narrative review

“…Perhaps the most devastating feature of sICH is the propensity for hematoma expansion (HE), which occurs in up to one third of patients ( 4 ) and is a significant predictor of mortality and poor functional outcomes ( 5 ). Nearly 40% of HE occurs within three hours of symptom onset ( 6 ), and its occurrence often precipitates neurologic deterioration as indicated by a decline in Glasgow Coma Scale (GCS) score.…”