Abstract
Despite years of effort, intracerebral hemorrhage (ICH) remains the most devastating form of stroke with more than 40% 30-day mortality worldwide. Hematoma expansion (HE), which occurs in one third of ICH patients, is strongly predictive of worse prognosis and potentially preventable if high-risk patients were identified in the early phase of ICH. In this review, we summarize data from recent studies on HE prediction and classify those potential indicators into four categories: clinical (severity of consciousness disturbance; blood pressure; blood glucose at and after admission); laboratory (hematologic parameters of coagulation, inflammation and microvascular integrity status), radiographic (interval time from ICH onset; baseline volume, shape and density of hematoma; intraventricular hemorrhage; especially the spot sign and modified spot sign) and integrated predictors (9-point or 24-point clinical prediction algorithm and PREDICT A/B). We discuss those predictors’ underlying pathophysiology in HE and present opportunities to develop future therapeutic strategies.
Highlights
Intracerebral hemorrhage (ICH), which accounts for 10-15% of stroke, is the most lethal form of stroke with more than 40% 30-day mortality compared to ischemic stroke [1, 2]
Hematoma expansion (HE), which occurs in approximately 33% ICH patients, is identified as one important independent predictor of early neurological deterioration and poor long-term clinical outcomes [3, 4]
We summarize and classify those potential predictors by clinical, laboratory, radiographic, and integrated score models
Summary
Intracerebral hemorrhage (ICH), which accounts for 10-15% of stroke, is the most lethal form of stroke with more than 40% 30-day mortality compared to ischemic stroke [1, 2]. One genetic research study demonstrated that increasing numbers of high blood pressure-related alleles are associated with mean baseline hematoma volume and poor clinical outcome in ICH [75].
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