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(Stroke. 2003;34:1680.)
© 2003 American Heart Association, Inc.

Original Contributions

Editorial Comment—Is There a Perihematomal Ischemic Penumbra? More Questions and an Overlooked Clue

National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland

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

"It is, of course, a trifle, but there is nothing so important as trifles."

— —Sherlock Holmes, as told by Arthur Conan Doyle

Compared with ischemic stroke, relatively little is known about the events leading to permanent parenchymal damage due to a primary intracerebral hematoma (ICH). It has been hypothesized that one aspect of the final pathology may be an ischemic penumbra surrounding the hematoma due in part to pressure exerted by the mass on surrounding vasculature. This hypothesis has been difficult to study in human ICH. If such a penumbra exists, then it may be most likely found in the sickest patients—those too unstable to tolerate study or those quickly referred to surgical intervention before the possibility of a penumbra can be investigated. Thus the dilemma of finding a penumbral signature in the first 6 hours is that one must examine a subgroup of ICH patients that may be less likely to demonstrate it. If a penumbra exists, could one detect it using MRI in the average hyperacute ICH patient available to study?

Would a perihemorrhagic ischemic penumbra have the same imaging features as the penumbra about an ischemic stroke? Are the cellular and molecular mechanisms that cause cerebral injury in perihemorrhagic ischemia the same as in a purely ischemic stroke? The biology of perihematomal ischemia may be quite different than that of pure ischemic stroke, as the brain is exposed to blood cells and molecules from which it is normally protected.^1–3 Required features of a penumbra in ischemic . . . [Full Text of this Article]

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