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(Stroke. 2008;39:1657.)
© 2008 American Heart Association, Inc.

Editorials

Are We Ready to Avert Suicide in Intracerebral Hemorrhage?

Jose I. Suarez, MD

From the Division of Vascular Neurology and Neurocritical Care, Department of Neurology, Baylor College of Medicine, Houston, Tex.

Correspondence to Jose I. Suarez, MD, Department of Neurology, Baylor College of Medicine, One Baylor Plaza, NB 302, Houston, TX 77030. E-mail jisuarez@bcm.tmc.edu

Key Words: apoptosis • ICH • edema • Fas receptor • Fas ligand • Soluble Fas • stroke

An extract of the first 250 words of the full text is provided, because this article has no abstract.

See related article, pages 1730–1734.

Stroke ranks third among all causes of death behind diseases of the heart and cancer.¹ Stroke accounts for about 1 in 16 deaths in the United States. Spontaneous intracerebral hemorrhage (ICH) comprises between 8% to 14% of all strokes but carries a mortality rate of up to 50% within the first 6 months after onset.¹ Functional outcome of ICH survivors is poor with only 20% of them regaining independence at 6 months. Despite such dismal statistics there has been little progress in the field of finding effective treatments that may positively impact the outcome of patients with ICH.

Several potential targets for treatment have been identified, tested or are currently undergoing testing in patients with ICH. For instance, one of the major determinants of outcome is hematoma volume.² The possibility of early surgical evacuation of ICH to reduce mortality has been proposed. However, the Surgical Trial in Intracerebral Hemorrhage (STICH) failed to demonstrate a difference between a policy of early surgery compared with a policy of initial conservative treatment.³ Other clinical trials evaluating the benefit of surgery in ICH are currently underway for lobar intracerebral hemorrhage (STICH II), intraventricular hemorrhage (CLEAR IVH), and for deep intracerebral hemorrhage and minimal invasive surgery (MISTIE).⁴ It has also become known that ICH is a dynamic process with hematoma volume expansion occurring in about 38% of patients within 20 hours.⁵ This may contribute to mass effect and neurological deterioration. A phase II study showed that treatment with rFVIIa . . . [Full Text of this Article]

Related Article:

Fas System Activation in Perihematomal Areas After Spontaneous Intracerebral Hemorrhage

Pilar Delgado, Eloy Cuadrado, Anna Rosell, José Álvarez-Sabín, Arantxa Ortega-Aznar, Mar Hernández-Guillamón, Anna Penalba, Carlos A. Molina, and Joan Montaner
Stroke 2008 39: 1730-1734. [Abstract] [Full Text] [PDF]