2015
DOI: 10.1038/nrneurol.2014.264
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Targeting secondary injury in intracerebral haemorrhage—perihaematomal oedema

Abstract: Perihaematomal oedema (PHO) is an important pathophysiological marker of secondary injury in intracerebral haemorrhage (ICH). In this Review, we describe a novel method to conceptualize PHO formation within the framework of Starling's principle of movement of fluid across a capillary wall. We consider progression of PHO through three stages, characterized by ionic oedema (stage 1) and progressive vasogenic oedema (stages 2 and 3). In this context, possible modifiers of PHO volume and their value in identifying… Show more

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Cited by 215 publications
(229 citation statements)
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“…Exclusion of patients who underwent surgery is also a strength of this analysis, since decompression alters edema volume measurements and often obscures the association of edema and poor outcome. 2 However, this exclusion limits the results of the present study to patients with ICH who do not have surgical intervention. This study has some important limitations.…”
Section: Discussionmentioning
confidence: 94%
See 1 more Smart Citation
“…Exclusion of patients who underwent surgery is also a strength of this analysis, since decompression alters edema volume measurements and often obscures the association of edema and poor outcome. 2 However, this exclusion limits the results of the present study to patients with ICH who do not have surgical intervention. This study has some important limitations.…”
Section: Discussionmentioning
confidence: 94%
“…1 PHE is hypothesised to occur following the activation of inflammatory pathways by haeme products. 2 Studies assessing the association between PHE and ICH outcomes have yielded conflicting results, perhaps due to small sample sizes, retrospective design and selection bias, and heterogeneity in the measurement techniques and timing of imaging. For instance, the relative edema volume, a ratio obtained by dividing PHE by the baseline haematoma volume (HV), 3 is limited by strong collinearity between PHE and HV and the tendency to be disproportionately higher in small haematomas compared with larger ones.…”
Section: Introductionmentioning
confidence: 99%
“…Although often related to sepsis, fever can also relate to an inflammatory reaction around the haematoma, as well as associated IVH or subarachnoid extension of the ICH 29. Animal studies suggest that induced hypothermia mitigates perihaematomal oedema by reducing several mediators of secondary brain injury, such as thrombin and the proinflammatory cytokines;30 preliminary clinical studies further support this action on perihaematomal oedema,31 an independent prognostic factor in ICH 32. It seems reasonable, therefore, that early treatment of fever should be safe and provide benefits to patients, but the results of several ongoing phase II trials, such as the Targeted Temperature Management after Intracerebral Hemorrhage (TTM-ICH)33 and Paracetamol (Acetaminophen) In Stroke 2 (PAIS 2)34 are awaited (table 2).…”
Section: Control Of Bp and Other Physiological Variablesmentioning
confidence: 99%
“…(1) A better understanding of ICH pathophysiology has led to interest in therapies that ameliorate secondary injury such as peri-hematomal edema (PHE). (24)…”
Section: Introductionmentioning
confidence: 99%