Despite substantial advances in neurovascular critical care, intracerebral hemorrhage (ICH) remains the deadliest form of stroke and a major cause of neurological disability. Well-designed trials of rational approaches such as hemostatic therapy1and early surgical evacuation2 have yielded some promising findings but no effective targeted therapies for improving ICH outcome. As a result, a recent set of guidelines for ICH management3 was able to identify very few treatments judged as both class I (benefit greatly exceeds risk) and level of evidence A (derived from multiple populations or randomized trials).
In thinking about current and future directions for ICH research, it is helpful to separate the process into 4 basic steps: the underlying cerebrovascular pathologies (almost exclusively involving small vessels of the brain), rupture of diseased vessel walls, hematoma expansion, and consequent damage to surrounding brain tissue. Articles in this section address each of these areas. Dean Li presents groundbreaking work on the molecular basis of vascular malformations, a potential model system for understanding other hemorrhage-prone vasculopathies and for developing new therapies to prevent vascular “leakage”. Crystal MacLellan compares various animal models of ICH with notably different patterns of hematoma expansion and tissue damage. Sander Connolly discusses approaches to neuroprotection of perihematoma brain tissue. Mariele Poels presents population-based data on the vascular ruptures detected as cerebral microbleeds on T2*-weighted MRI. And William Powers discusses the parallels between ipsi- and contralateral damage caused by an intracerebral hematoma and that caused by traumatic brain injury. The summary impression from these presentations is that the biology of ICH offers many promising avenues for improved understanding and potentially improved treatment for this challenging disorder.
- Received June 29, 2010.
- Accepted July 16, 2010.
Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, Karimi A, Shaw MD, Barer DH. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the international surgical trial in intracerebral haemorrhage (STICH): A randomised trial. Lancet. 2005; 365: 387–397.
Morgenstern LB, Hemphill JC III, Anderson C, Becker K, Broderick JP, Connolly ES, Greenberg SM, Huang JN, Macdonald L, Messe SR, Mitchell PH, Selim M, Tamargo RJ. Guidelines for the management of spontaneous intracerebral hemorrhage: a statement for healthcare professionals from the American Heart Association/American Stroke Association council on stroke. Stroke. 2010: 41: 2108–2129.