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(Stroke. 2007;38:746.)
© 2007 American Heart Association, Inc.

Intracerebral Hemorrhage: Introduction

Intracerebral Hemorrhage

Introduction

Steven M. Greenberg, MD, PhD

From the Department of Neurology, Massachusetts General Hospital, Boston, Mass.

Correspondence to Steven M. Greenberg, MD, PhD, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA 02114. E-mail sgreenberg@partners.org

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

The starting point for any discussion of intracerebral hemorrhage (ICH) is that it is a bad disease. Despite improvements in neurological intensive care (and concerns that ICH outcome may be worsened by physician pessimism¹), the fact remains that fewer than one-third of ICH victims make a good functional recovery.^2,3 Another study examining trends in ICH outcome found essentially no improvement between 1988 (1-year mortality of 59%) and 1998 to 2003 (1-year mortality 53%),⁴ likely reflecting the lack of proven treatments for acute ICH. The incidence of ICH should remain stable or rise, as ongoing improvements in blood pressure control are offset by other trends that favor ICH occurrence such as aging of the population, greater use of anticoagulants and thrombolytics, and the absence of preventive treatment for cerebral amyloid angiopathy.

There are grounds for optimism in the acute ICH field, however, as presented in the accompanying articles by Lo, Wagner, Xi, and Mayer. Hemostatic therapy with recombinant activated factor VII, though still unproven by a phase III study, has emerged as a promising approach to preventing hematoma expansion if administered early after acute ICH.³ Further positive news is offered by advances in animal models of ICH. These studies have yielded a growing list of rational biological targets for potential therapies, including matrix metalloproteinases (MMPs), thrombin, iron, glutamate, inflammation, oxidative stress, and perihematoma hypoperfusion.^5,6

As we await results from the phase III study of recombinant activated factor VII, the prospect of having other candidate approaches to acute ICH raises the . . . [Full Text of this Article]