Reversible ischemia around intracerebral hemorrhage: a single-photon emission computerized tomography study

Siddique, M. Shahid; Fernandes, Hilda; Wooldridge, Thomas D.; Fenwick, John D.; Slomka, Piotr J.; Mendelow, A. D.

doi:10.3171/jns.2002.96.4.0736

Cited by 96 publications

(48 citation statements)

References 31 publications

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“…There is direct experimental evidence of ischemic tissue surrounding the hematoma, 43,44 and radiologic support is also available. [45][46][47] On the other hand, several clinical studies have not demonstrated the presence of perihematomal penumbra. [48][49][50][51] This phenomenon seems to be present in some patients but not all.…”

Section: Pathophysiologymentioning

confidence: 99%

Update in Intracerebral Hemorrhage

Aguilar

Brott

2011

The Neurohospitalist

127

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Spontaneous, nontraumatic intracerebral hemorrhage (ICH) is defined as bleeding within the brain parenchyma. Intracranial hemorrhage includes bleeding within the cranial vault and encompasses ICH, subdural hematoma, epidural bleeds, and subarachnoid hemorrhage (SAH). This review will focus only on ICH. This stroke subtype accounts for about 10% of all strokes. The hematoma locations are deep or ganglionic, lobar, cerebellar, and brain stem in descending order of frequency. Intracerebral hemorrhage occurs twice as common as SAH and is equally as deadly. Risk factors for ICH include hypertension, cerebral amyloid angiopathy, advanced age, antithrombotic therapy and history of cerebrovascular disease. The clinical presentation is ''stroke like'' with sudden onset of focal neurological deficits. Noncontrast head computerized tomography (CT) scan is the standard diagnostic tool. However, newer neuroimaging techniques have improved the diagnostic yield in terms of underlying pathophysiology and may aid in prognosis. Intracerebral hemorrhage is a neurological emergency. Medical care begins with stabilization of airway, breathing function, and circulation (ABCs), followed by specific measures aimed to decrease secondary neurological damage and to prevent both medical and neurological complications. Reversal of coagulopathy when present is of the essence. Blood pressure management can be key and continues as an area of debate and ongoing research. Surgical evacuation of ICH is of unproven benefit though a subset of well-selected patients may have improved outcomes. Ventriculostomy and intracranial pressure (ICP) monitoring are interventions also used in this patient population. To date, hemostatic medications and neuroprotectants have failed to result in clinical improvement. A multidisciplinary approach is recommended, with participation of vascular neurology, vascular neurosurgery, critical care, and rehabilitation medicine as the main players.

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Section: Pathophysiologymentioning

confidence: 99%

Update in Intracerebral Hemorrhage

Aguilar

Brott

2011

The Neurohospitalist

127

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“…Various imaging techniques are employed to study ongoing secondary neuronal injury in the perihematomal region, including positron emission tomography (PET), single photon emission computed tomography (SPECT), MR perfusion, and CT [19,[38][39][40][41][42][43][44][45][46][47][48]. Specifically, the results of PET studies have not shown evidence of hypoxia or ischemia (i.e., normal oxygen extraction fraction and 18 F-fluoromisonidazole uptake) surrounding the intraparenchymal hemorrhage.…”

Section: New Imaging Techniquesmentioning

confidence: 99%

Neuroimaging of Hemorrhage and Vascular Defects

2011

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Summary: Intracranial hemorrhage is the third most common cause of stroke and involves the accumulation of blood within brain parenchyma or the surrounding meningeal spaces. Accurate identification of acute hemorrhage and correct characterization of the underlying pathology, such as tumor, vascular malformation, or infarction, is a critical step in planning appropriate therapy. Neuroimaging studies are required not only for diagnosis, but they also provide important information on the type of hemorrhage, etiology, and the pathophysiological process. Historically, computed tomography (CT) scan has been the diagnostic imaging study of choice; however, there is growing evidence suggesting that magnetic resonance imaging (MRI) is at least as sensitive as CT to detect intraparenchymal hemorrhages in the hyperacute setting, and actually superior to CT in the subacute and chronic settings. Unique MRI and CT characteristics differentiate secondary causes of hemorrhage from the more common hypertensive hemorrhage. Baseline and serial studies can be used to identify patients who might benefit from acute interventions. In addition, new imaging modalities, (such as magnetic resonance spectroscopy, diffusion tensor imaging, and 320-row CT) are promising research techniques that have the potential to enhance our understanding of the tissue injury and recovery after intracranial hemorrhages.

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“…There is controversy whether secondary ischemia contributes to brain injury after SICH. 51,80,111,114,136 Cushing 29 believed that brain injury due to SICH was the result of local pressure compressing the microcirculation and causing ischemia around a hematoma. Astrup, et al, 5 proposed the term "ischemic penumbra" to describe brain with CBF values above a lower limit of membrane dysfunction and cell death, but below an upper limit corresponding to electrophysiological dysfunction.…”

Section: Pathophysiological Mechanismsmentioning

confidence: 99%

“…80 In a small study in which positron emission tomography was used, no zone of tissue hypoxia or "ischemic penumbra" was identified. 51 Siddique and colleagues, 114 however, analyzed serial SPECT scans obtained in patients with SICH and identified perilesional hypoperfusion. They were also able to demonstrate that some of the ischemic perilesional brain recovered its perfusion in the long term.…”

Section: Pathophysiological Mechanismsmentioning

confidence: 99%

Spontaneous intracerebral hemorrhage: a review

Fewel¹,

Thompson²,

Hoff³

2003

FOC

143

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Spontaneous intracerebral hemorrhage (SICH) is a blood clot that arises in the brain parenchyma in the absence of trauma or surgery. This entity accounts for 10 to 15% of all strokes and is associated with a higher mortality rate than either ischemic stroke or subarachnoid hemorrhage. Common causes include hypertension, amyloid angiopathy, coagulopathy, vascular anomalies, tumors, and various drugs. Hypertension, however, remains the single greatest modifiable risk factor for SICH. Computerized tomography scanning is the initial diagnostic modality of choice in SICH, and angiography should be considered in all cases except those involving older patients with preexisting hypertension in thalamic, putaminal, or cerebellar hemorrhage. Medical management includes venous thrombosis prophylaxis, gastric cytoprotection, and aggressive rehabilitation. Anticonvulsant agents should be prescribed in supratentorial SICH, whereas the management of hypertension is controversial. To date, nine prospective randomized controlled studies have been conducted to compare surgical and medical management of SICH. Although definitive evidence favoring surgical intervention is lacking, there is good theoretical rationale for early surgical intervention. Surgery should be considered in patients with moderate to large lobar or basal ganglia hemorrhages and those suffering progressive neurological deterioration. Elderly patients in whom the Glasgow Coma Scale score is less than 5, those with brainstem hemorrhages, and those with small hemorrhages do not typically benefit from surgery. Patients with cerebellar hemorrhages larger than 3 cm, those with brainstem compression and hydrocephalus, or those exhibiting neurological deterioration should undergo surgical evacuation of the clot. It is hoped that the forthcoming results of the International Surgical Trial in IntraCerebral Hemorrhage will help formulate evidence-based recommendations regarding the role of surgery in SICH.

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Reversible ischemia around intracerebral hemorrhage: a single-photon emission computerized tomography study

Cited by 96 publications

References 31 publications

Update in Intracerebral Hemorrhage

Update in Intracerebral Hemorrhage

Neuroimaging of Hemorrhage and Vascular Defects

Spontaneous intracerebral hemorrhage: a review

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