Hyperacute management of intracerebral haemorrhage

Abstract

s9-s12 STROKE on the day of admission than ischaemic strokes (odds ratio: 7.27, 95% CI: 6.31-8.37, p<0.001).2 However, there has been a growing interest in ICH in the stroke research community and findings from recent studies suggest that a more active approach to this patient group is now warranted. We will focus this review on evidence for key interventions in the hyperacute phase of ICH management, that is, the first 24 hours after symptom onset. Early neurological deteriorationIn ICH, a key pathophysiological difference from ischaemic stroke is the presence within the fixed volume of the cranium of a space-occupying lesion, initially composed of the haematoma and subsequently, an increasing volume of vasogenic oedema. 4Should the reserve of space within the cranium be exhausted (Monro-Kellie doctrine), intracranial pressure will begin to rise and fatal brain herniation syndromes may then occur. Baseline haematoma volume is an important predictor of survival and functional outcomes but subsequent early complications that increase intracranial pressure can cause early neurological deterioration in up to half of patients, depending on how it is defined and study duration. 5,6 Haematoma expansion (Fig 1 ) is a principal cause of deterioration in the first 24 hours after onset, with studies indicating that up to 30% of patients demonstrate significant haematoma expansion within hours of onset, which worsens prognosis. 7 Obstructive hydrocephalus may occur with occlusion of cerebrospinal fluid flow, either by occlusion of the ventricular system by intraventricular haemorrhage or extrinsic compression, especially at the third and fourth ventricles. Finally, for larger haematomas in the subacute phase, the addition of Intracerebral haemorrhage causes 1 in 10 strokes, but has the worst overall outcomes of all stroke subtypes. Baseline haematoma volume is a key prognostic factor and early complications -such as haematoma expansion, obstructive hydrocephalus and perihaematomal oedema -may worsen outcome. There is evidence that withdrawal of care may occur more often in intracerebral haemorrhage than ischaemic stroke independent of premorbid health and stroke severity. However, recent evidence shows that reversal of anticoagulants, intensive blood pressure lowering and surgery in carefully selected cases may improve outcomes. Ongoing research may also provide evidence for new medical treatments and minimally invasive approaches to surgery. Effective implementation of evidence-based care to intracerebral haemorrhage patients can be diffi cult but quality improvement methodology can help to achieve maximal benefi t.

Kurarinone alleviates hemin‐induced neuroinflammation and microglia‐mediated neurotoxicity by shifting microglial M1/M2 polarization via regulating the IGF1/PI3K/Akt signaling

“…Cerebral hemorrhage can be caused by many factors, including hypertension, cerebral amyloid angiopathy, alcohol consumption, smoking, high cholesterol, statin use, diabetes, and genetics 2 . Acute cerebral hemorrhage is life‐threatening, but therapeutic effect is not ideal 25 . In the present clinical work, clinical and imaging characteristics are very important for the determination of etiology and prognosis 26 .…”

“…2 Acute cerebral hemorrhage is life-threatening, but therapeutic effect is not ideal. 25 In the present clinical work, clinical and imaging characteristics are very important for the determination of etiology and prognosis. 26 The survival and recovery of patients with cerebral hemorrhage are closely related to the site, amount, and intracranial pressure of hemorrhage.…”

“…26 The survival and recovery of patients with cerebral hemorrhage are closely related to the site, amount, and intracranial pressure of hemorrhage. 25 Local neurotoxicity or inflammation caused by cerebral hematoma can cause neurological dysfunction. 27 Therefore, it is very important to find drugs that can effectively reduce neuroinflammation and damage 6,8 Activated microglia could release inflammatory mediators, including cytokines and reactive oxygen.…”

“…In the present clinical work, clinical and imaging characteristics are very important for the determination of etiology and prognosis 26 . The survival and recovery of patients with cerebral hemorrhage are closely related to the site, amount, and intracranial pressure of hemorrhage 25 . Local neurotoxicity or inflammation caused by cerebral hematoma can cause neurological dysfunction 27 .…”

Exoskeletal wearable robot on ambulatory function in patients with stroke: a protocol for an international, multicentre, randomised controlled study

“…Stroke is reported as one of the leading causes of disability in adults 1. Recent advances in hyperacute and acute management have led to a significant impact on clinical and functional outcomes of patients with stroke 2 3. However, hyperacute management such as revascularisation therapy can only be applied to a limited population of patients with stroke2 and many patients with stroke are still suffering from significant motor impairments and gait disturbance 1.…”