Abstract
Intracerebral hemorrhage (ICH) has one of the worst prognoses among patients with stroke. Surgical measures have been adopted to relieve the mass effect of the hematoma, and developing targeted therapy against secondary brain injury (SBI) after ICH is equally essential. Numerous preclinical and clinical studies have demonstrated that perihematomal edema (PHE) is a quantifiable marker of SBI after ICH and is associated with a poor prognosis. Thus, PHE has been considered a promising therapeutic target for ICH. However, the findings derived from existing studies on PHE are disparate and unclear. Therefore, it is necessary to classify, compare, and summarize the existing studies on PHE. In this review, we describe the growth characteristics and relevant underlying mechanism of PHE, analyze the contributions of different risk factors to PHE, present the potential impact of PHE on patient outcomes, and discuss the currently available therapeutic strategies.
Highlights
The prognosis of patients with hemorrhagic stroke is extremely poor, resulting in long hospital stays and high costs [1]
The development of Perihematomal edema (PHE) has been considered a quantifiable marker of secondary brain injury (SBI) and is associated with thrombin activation, an inflammatory immune response, blood–brain barrier (BBB) dysfunction, and hemoglobin cytotoxicity after intracerebral hemorrhage (ICH) [4,5,6]
The International Surgical Trial in Intracerebral Hemorrhage (STICH) I and II showed no clinical benefit of early surgical evacuation of the hematoma in patients with ICH [7, 8]; whether targeted treatment for PHE can provide favorable effects has become of great interest to researchers
Summary
The prognosis of patients with hemorrhagic stroke is extremely poor, resulting in long hospital stays and high costs [1]. One study showed that an early peak in PHE growth may be associated with rupture of the hematoma into the ventricle [16] This may be clinically relevant because a high hematocrit indicates higher red blood cell (RBC) degradation, which has been identified as an essential factor for promotion of PHE. Because the time to initial CT was longer in the celecoxib group than in the control group in that study, the primary outcome was defined as a ≥20% change in PHE from onset to an average of 1 week, which may be inappropriate because a longer time to initial CT may represent a steady state for PHE [10, 98] Antiadrenergic drugs such as b-blockers and a2-agonists have been used to manage hypertension in patients with ICH. Li et al recently performed an unbiased genome-wide transcript sequencing study for surgical removal of perihematomal brain tissue in patients with ICH and Frontiers in Immunology | www.frontiersin.org
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
